In 1897, the physician Robert Taylor stated “in the case of a woman performance of the sexual act, at least so far as her partner is concerned, requires only the presence of a sufficiently long and patulous mucous canal.” Dr. Taylor went on to discuss some aspects of female sexuality and means to improve upon women’s sexual satisfaction. However, he concluded that for many women “pleasure in the sexual act is not to be excited; nor is this to be regretted, since such women make good wives, loving mothers, and are not tempted to stay in the paths which the comparatively small number of their more amorous sisters at times find too alluring” (Taylor, 1897).
While we may be nonplussed at the quaint misogyny of Taylor’s statements, the fact remains that over 120 years later the medical communities understanding of, and interest in, female sexuality lags far behind that of our understanding of men’s sexuality. There are numerous potential reasons for this disparity; however, it is no longer acceptable to justify that disparity on the outmoded concept that women’s sexuality is simply more complex then men’s and is therefore inscrutable (Shindel and Goldstein, 2016).
The concept of sexual wellness has been described as (WHO, 2006)
A state of physical, emotional, mental, and social well-being in relation to sexuality
Not merely the absence of disease, dysfunction, and/or infirmity
An important and integral aspect of human development and maturation
A human right
Physical and psychological issues may impair sexual wellness and diminish quality of life (Davison et al, 2009). As treatment of biomedical problems fall within the expertise of healthcare providers, these issues merit close consideration during medical consultations. While these physical and mental issues may be the principal focus of healthcare providers, it is important that the emotional and cultural aspects of sexuality be considered when providing advice and care to any individual with sexual concerns.
Sexuality concerns are not infrequent in women presenting for urologic care; furthermore, sexual interest and activity persists at least into the ninth decade for some women (Elsamra et al, 2010; Waite et al, 2009). However, urologists and other providers rarely consider these issues during routine practice (Bekker et al, 2009; Sobecki et al, 2012). It behooves all practicing physicians, particularly those who provide care for women’s urological and gynecological issues, to be well versed in the physiology and pathophysiology of female sexuality (Shindel and Goldstein, 2016).
Human sexual response is modulated by a complex interplay of neurological, vascular, hormonal, and sociocultural factors (Schober and Pfaff, 2007). Classically, sexual responses were categorized as a linear process of desire, arousal, sexual plateau, orgasm, and resolution (Kaplan, 1977; Masters and Johnson, 1966). Each phase of sexual response is associated with physical and mental changes (Table 40–1).