Clinical Autonomic Research

, Volume 11, Issue 5, pp 279–283 | Cite as

Neurogenic female sexual dysfunction: A review

  • Marca L. Sipski
  • Anousheh Behnegar
Review Article


The effect of various spinal lesions on female sexual response has recently been investigated in detail. Studies of women with neurologic disabilities and studies of animal models have provided substantial information regarding the spinal control of sexual responses. In this report, the authors explore findings regarding the neurologic pathways underlying the spinal control of sexual arousal and orgasm. Information available about the effects of multiple sclerosis and various cerebral disorders on female sexual function will also be reviewed, with special attention to areas where further research is needed. Lastly, the current status and techniques available to improve the sexual functioning of women with neurologic disabilities affecting the central nervous system will be reviewed.

Key words

female sexual response spinal cord injury multiple sclerosis brain injury sexuality 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Basson R, Berman J et al. Report of the International Consensus Development Conference on female sexual dysfunction: definitions and classifications.J Urol 2000: 163:888–893.CrossRefPubMedGoogle Scholar
  2. 2.
    Berman JR, Berman LA, et al. Female sexual dysfunction: anatomy, physiology, evaluation and treatment options.Curr Opin Urol 1999; 9:563–568.CrossRefPubMedGoogle Scholar
  3. 3.
    Laumann EO, Pail A, Rosen RC. Sexual Dysfunction in the United States.JAMA 1999; 281:537–544.CrossRefPubMedGoogle Scholar
  4. 4.
    Fitting MD, Salisbury S, Davies NH, et al. Self-concept and sexuality of spinal cord injured women.Arch Sex Behav 1978; 7:143–156.CrossRefPubMedGoogle Scholar
  5. 5.
    Charlifue SW, Gerhart KA, Menter RR, et al. Sexual issues of women with spinal cord injuries.Paraplegia. 1992; 30:192–199.PubMedGoogle Scholar
  6. 6.
    Sipski ML, Alexander CJ. Sexual activities, response and satisfaction in women pre- and post-spinal cord injury.Arch Phys Med Rehabil 1993; 74:1025–1029.CrossRefPubMedGoogle Scholar
  7. 7.
    Bors E, Comarr AE. Neurological disturbances of sexual function with special reference to 529 patients with spinal cord injury.Urol Surv 1970; 110:191–221.Google Scholar
  8. 8.
    Sintchak G, Geer JH. A vaginal photoplethysmograph, system.Psychophysiology 1975; 12:113–155.PubMedGoogle Scholar
  9. 9.
    Rosen RC, Beck JF. Genital blood flow measurement in the female: psychophysiological techniques. In:Patterns of sexual arousal. New York: The Guilford Press; 1988. pp. 78–107.Google Scholar
  10. 10.
    Sipski ML, Alexander CJ, Rosen RC, Physiological parameters associated with psychogenic sexual arousal in women with complete spinal cord injuries.Arch Phys Med Rehabil 1995; 76:811–818.PubMedGoogle Scholar
  11. 11.
    Sipski ML, Alexander CJ, Rosen RC. Physiologic parameters associated with sexual arousal in women with incomplete spinal cord injuries.Arch Phys Med Rehabil 1997; 78:305–313.CrossRefPubMedGoogle Scholar
  12. 12.
    Sipski, ML, Alexander CJ, Rosen RC. Sexual arousal and orgasm in women: effects of spinal cord injury.Ann Neurol 2001; 49:35–44.CrossRefPubMedGoogle Scholar
  13. 13.
    Watson C.Basic human neuroanatomy. Boston: Little, Brown and Company; 1995. pp. 13–21.Google Scholar
  14. 14.
    Meston CM, Gorzalka BB. The differential effects of sympathetic activation on sexual arousal in sexually functional and dysfunctional women.J Abnorm Psychol 1996; 34:143–148.Google Scholar
  15. 15.
    Palace EM, Gorzalka BB. The enhancing effects of anxiety on arousal in sexually dysfunctional and functional women.J Abnorm Psychol 1990; 99:403–411.CrossRefPubMedGoogle Scholar
  16. 16.
    Meston CM, Heiman JR. Ephedrine-activated physiological sexual arousal in women.Arch Gen Psychiatry 1998; 55:652–656.PubMedGoogle Scholar
  17. 17.
    McKenna KE. The neural control of female sexual function.Neurorehabilitation 2000; 15:133–143.PubMedGoogle Scholar
  18. 18.
    Chung SK, McKenna KE. The autonomic innervation of the penis and clitoris of the rat.Soc. Neurosci 1987; 13:272 (abstract).Google Scholar
  19. 19.
    Sipski ML, Alexander CJ, Rosen RC. Orgasm in women with spinal cord injuries: A laboratory-based assessment.Arch Phys Med Rehabil 1995; 76:1097–1102.PubMedGoogle Scholar
  20. 20.
    Sherfey MJ.The nature and evolution of female sexuality. New York: Random House; 1966.Google Scholar
  21. 21.
    Mould DE. Neuromuscular aspects of women's orgasms.J Sex Res 1980; 16:193–201.Google Scholar
  22. 22.
    Kaplan HS.The new sex therapy. New York: Brunner/Mazel; 1974.Google Scholar
  23. 23.
    Kaplan JS. The classification of the female sexual dysfunctions.J. Sex Marital Ther 1974; 1:124–128.PubMedGoogle Scholar
  24. 24.
    Whipple B, Gerdes CA, Komisaruk BR. Sexual response to selfstimulation in women with complete spinal cord injury.J Sex Res 1996; 33:231–240.Google Scholar
  25. 25.
    Komisaruk BR, Bianca R, et al. Brain-mediated responses to vaginocervical stimulation in spinal cord-transected rats: role of the vagus nerves.Brain Res 1996; 708:128–134.CrossRefPubMedGoogle Scholar
  26. 26.
    McKenna KE, Chung SK, McVary KKT. A model for the study of sexual function in anesthetized male and female rats.Am J Physiol 1991; 261:T1276–1285.Google Scholar
  27. 27.
    Miller LS, Staas WE, Herbison GJ. Abdominal problems in patients with spinal cord lesion.Arch Phys Med Rehabil 1975; 56:405–408.PubMedGoogle Scholar
  28. 28.
    Axel SJ. Spinal cord injured women's concerns: menstruation and pregnancy.Rehabil Nursing 1982; 7:10–15.Google Scholar
  29. 29.
    Sun W-M, MacDonagh R, Forster D et al. Anorectal function in patients with complete spinal transection before and after sacral posterior rhizotomy.Gastroenterology 1994; 108:990–998.Google Scholar
  30. 30.
    Ragnarsson KT. Management of pain in persons with spinal cord injury.J. Spinal Cord Med 1997; 20:186–199.PubMedGoogle Scholar
  31. 31.
    Sipski ML, Alexander CJ. Sexuality and disability. In:Reehabilitation medicine: principles and practice. 3rd ed. DeLisa JA, Gans BM, eds. Philadelphia: Lippincott-Raven; 1998. pp. 1107–1129.Google Scholar
  32. 32.
    Lillius HG, Valtonen CJ, Wikstrom J. Sexual problems in patients suffering from multiple sclerosis.J Chron Dis 1976; 19:643–647.Google Scholar
  33. 33.
    Barak Y, Achiron A, Elizur A, et al. Sexual dysfunction in relapsing-remitting multiple sclerosis: magnetic resonance imaging, clinical, and psychological correlates.J Psychiatry Neurosci 1996; 21:255–258.PubMedGoogle Scholar
  34. 34.
    Hulter BM, Lundberg PO. Sexual function in women with advance multiple sclerosis.J Neurol Neurosurg Psychiatry 1995; 59:83–86.PubMedGoogle Scholar
  35. 35.
    Valleroy ML, Kraft GH. Sexual dysfunction in multiple sclerosis.Arch Phys Med Rehabil 1984; 65:125–128.PubMedGoogle Scholar
  36. 36.
    Yang CC, Bowen JR, Kraft GH, et al. Cortical evoked potentials of the dorsal nerve of the clitoris and female sexual dysfunction in multiple sclerosis.J Urol 2000; 164:2010–2013.PubMedGoogle Scholar
  37. 37.
    Sagar SM, Sharp FR, Curran. Expression of c-fos protein in brain: Metabolic mapping at the cellular level.Science 1988; 240:1326–1332.Google Scholar
  38. 38.
    Hubscher CH, Johnson RD. Responses of medullary reticular formation neurons to input from the male genitalia.J Neurophysiol 1996; 76:2474–2482.PubMedGoogle Scholar
  39. 39.
    Marson L, McKenna KE. The identification of a brainstem site controlling spinal sexual reflexes in male rats.Brain Res 1990; 515:303–308.CrossRefPubMedGoogle Scholar
  40. 40.
    Marson L, McKenna KE. A role for 5-hydroxytryptamine in mediating spinal sexual reflexes.Exp Brain Res 1992:88:313–320.CrossRefPubMedGoogle Scholar
  41. 41.
    Behbehani MM. Functional characteristics of the midbrain periaqueductal gray.Proy Neurobiol 1995; 46:574–605.Google Scholar
  42. 42.
    Sandel ME, Williams KKS, Dellapietra L, et al. Sexual functioning following traumatic brain injury.Brain Inj 1996; 10:719–728.CrossRefPubMedGoogle Scholar
  43. 43.
    Kreuter M, Dahllof AG, Gudjonsson G, et al. Sexual adjustment and its predictors after traumatic brain injury.Brain Inj 2998; 12:349–368.Google Scholar
  44. 44.
    Hibbard MR, Gordon WA, Flanagan S, et al. Sexual dysfunction after traumatic brain injury.Neurorehabilitation 2000; 15:107–120.PubMedGoogle Scholar
  45. 45.
    Hulter B, Lundberg PO. Sexual Function in women with hypothalamo-pituitary disorders.Arch Sex Behav 1994; 23:171–183.CrossRefPubMedGoogle Scholar
  46. 46.
    Korpelainen JT, Kauhanen JL, Kemola H, et al. Sexual dysfunction in stroke patients.Acta Neurol Scand 1998; 98:400–405.PubMedGoogle Scholar
  47. 47.
    Korpelainen JT, Nieminen P, Myllyla VV. Sexual functioning among stroke patients and their spouses.Stroke 1999; 30:715–719.PubMedGoogle Scholar
  48. 48.
    Sipski ML. A physiatrist's views regarding the report of the international consensus conference on female dysfunction: Potential concerns regarding women with disabilities.J Sex Marital Ther 2001; 27:215–216.PubMedGoogle Scholar
  49. 49.
    Sipski ML, Rosen RC, Alexander CJ, et al. A controlled trial of positive feedback to increase, sexual arousal in women with spinal cord injuries.Neurorehabilitation. 2000; 15:145–153.PubMedGoogle Scholar
  50. 50.
    Park K, Moreland RB, Goldstein I, et al. Sildenafil inhibits phosphodiesterase type 5 in human clitoral corpus cavernosum smooth muscle.Biochem Biophys Res Commun 1998; 249:612–617.CrossRefPubMedGoogle Scholar
  51. 51.
    Derry FA, Dinsmore WW, Fraser M, et al. Efficacy and safety of oral sildenafil (Viagra) in men with erectile dysfunction caused by spinal cord injury.Neurology 1998; 51:1629–1633.PubMedGoogle Scholar
  52. 52.
    Maytom MC, Derry FA, Dinsmore WW, et al. A two-part pilot study of sildenafil (Viagra) in men with erectile dysfunction caused by spinal cord injury.Spinal Cord 1999; 37:110–116.CrossRefPubMedGoogle Scholar
  53. 53.
    Sipski ML, Rosen RC, Alexander CJ, et al. Sildenafil effects on sexual and cardiovascular responses in women with spinal cord injury.Urology 2000; 6:812–815.Google Scholar

Copyright information

© Lippincott Williams & Wilkins 2001

Authors and Affiliations

  • Marca L. Sipski
    • 1
    • 2
  • Anousheh Behnegar
    • 3
  1. 1.Department of Veteran AffairsUniversity of Miani School of MedicineMiamiUSA
  2. 2.Miami Project to Cure Paralysis, Department of Neurological SurgeryUniversity of Miami School of MedicineMiamiUSA
  3. 3.Mt. Sinai School of MedicineNew YorkUSA

Personalised recommendations