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Local Responses to Genital Arousal — Mechanisms of Lubrication

  • Preclinical and Psychophysiology (F Guarraci, Section Editor)
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Abstract

Purpose of Review

The aim of this review is to outline the anatomical and physiological processes involved in vaginal lubrication and to examine the current options for its measurement in the laboratory.

Recent Findings

The literature suggests that androgens and estrogens play a crucial role in the maintenance of vaginal structure and vascular functions, thereby delivering positive downstream effects on vaginal lubrication. Estrogens and androgens help maintain healthy genital tissue and capillary beds. During sexual arousal, interactions among these hormones with various peptides encourage genital vasocongestion, which, by way of increased pressure on surrounding cells, is believed to facilitate lubrication. Litmus strips and Schirmer Tear Test strips circumvent many pitfalls of previous objective measurements and appear to be viable methods for assessing vaginal lubrication in the laboratory.

Summary

Vaginal lubrication is believed to result from increased vasocongestion and appears to be modulated by sex steroid hormones. Preliminary support has emerged for the use of litmus strips and Schirmer Tear Test strips to measure lubrication in response to sexual films in the laboratory, though more research is needed to determine the psychometric properties of these applications.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Basson R. Human sexual response. In: Handbook of clinical neurology. Elsevier, 2015:130:11–18. https://doi.org/10.1016/B978-0-444-63247-0.00002-X.

  2. Janssen E, Everaerd W, Spiering M, Janssen J. Automatic processes and the appraisal of sexual stimuli: toward an information processing model of sexual arousal. J Sex Res. 2000;37:8–23. https://doi.org/10.1080/00224490009552016.

    Article  Google Scholar 

  3. Spiering M, Everaerd W, Janssen E. Priming the sexual system: implicit versus explicit activation. J Sex Res. 2003;40:134–45. https://doi.org/10.1080/00224490309552175.

    Article  PubMed  Google Scholar 

  4. Chivers ML, Seto MC, Lalumière ML, Laan E, Grimbos T. Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis. Arch Sex Behav. 2010;39:5–56. https://doi.org/10.1007/s10508-009-9556-9.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Parish SJ, Goldstein AT, Goldstein SW, et al. Toward a more evidence-based nosology and nomenclature for female sexual dysfunctions—part II. J Sex Med. 2016;13:1888–906. https://doi.org/10.1016/j.jsxm.2016.09.020.

    Article  PubMed  Google Scholar 

  6. Althof SE, Meston CM, Perelman MA, Handy AB, Kilimnik CD, Stanton AM. Opinion paper: on the diagnosis/classification of sexual arousal concerns in women. J Sex Med. 2015;14:1365–71. https://doi.org/10.1016/j.jsxm.2017.08.013.

    Article  Google Scholar 

  7. Lalumière ML, Sawatsky ML, Dawson SJ, Suschinsky KD. The empirical status of the preparation hypothesis: explicating women’s genital responses to sexual stimuli in the laboratory. Arch Sex Behav. 2020;51:709–28. https://doi.org/10.1007/s10508-019-01599-5.

    Article  PubMed  Google Scholar 

  8. Levin RJ. The ins and outs of vaginal lubrication. Sex Relatsh Ther. 2003;18:509–13. https://doi.org/10.1080/14681990310001609859.

    Article  Google Scholar 

  9. Jozkowski KN, Peterson ZD. College students and sexual consent: unique insights. J Sex Res. 2013;50(6):517–23. https://doi.org/10.1080/00224499.2012.700739.

    Article  PubMed  Google Scholar 

  10. Berman JR. Physiology of female sexual function and dysfunction. Int J Impot Res. 2005;17(1):S44-51.

    Article  PubMed  Google Scholar 

  11. Clark GL, Pokutta-Paskaleva AP, Lawrence DJ, Lindsey SH, Desrosiers L, Knoepp LR, et al. Smooth muscle regional contribution to vaginal wall function. Interface Focus. 2019;9(4):20190025. https://doi.org/10.1098/rsfs.2019.0025.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hoyle CH, Stones RW, Robson T, Whitley K, Burnstock G. Innervation of vasculature and microvasculature of the human vagina by NOS and neuropeptide-containing nerves. J Anat. 1996;188(Pt 3):633.

    PubMed  PubMed Central  Google Scholar 

  13. Dubinskaya A, Guthrie T, Anger JT, Eilber KS, Berman JR. Local genital arousal: mechanisms for vaginal lubrication. Curr Sex Health Rep. 2021:45–53. https://doi.org/10.1007/s11930-021-00305-8. This paper reviewed the existing literature on female sexual arousal with a focus on genital arousal and mechanisms of lubrication. Current treatment options for female sexual arousal disorder were discussed.

  14. Masters WH, Johnson VE. Human sexual response. 1st ed. Little: Brown & Co.; 1966.

    Google Scholar 

  15. Park K, Kim NN. Anatomy and physiology of arousal. Textbook of female sexual function and dysfunction: diagnosis and treatment. 2018 May 22:107-25.

  16. Jannini EA, d’Amati G, Lenzi A. Histology and immunohistochemical studies of female genital tissue. Women’s sexual function and dysfunction: study, diagnosis and treatment. London: Taylor and Francis. 2006:125–33.

  17. Omole F, Kelsey RC, Phillips K, Cunningham K. Bartholin duct cyst and gland abscess: office management. Am Fam Physician. 2019;99(12):760–6.

    PubMed  Google Scholar 

  18. Giraldi, A, & Levin, RJ. Vascular physiology of female sexual function. In I. Goldstein, C. M. Meston, S. R. Davis, & A. M. Traish (Eds.) Women’s sexual function and dysfunction: study, diagnosis and treatment 2006:174–180. Boca Raton, Florida: Taylor & Francis. https://doi.org/10.1016/j.jsxm.2016.02.172.

  19. Levin RJ, Wagner G. Human vaginal fluid-ionic composition and modification by sexual arousal [proceedings]. J Physiol. 1977;266(1):62P-63P.

    CAS  PubMed  Google Scholar 

  20. Wagner G, Levin R. Oxygen tension of the vaginal surface during sexual stimulation in the human. Fertil Steril. 1978;30(1):50–3. https://doi.org/10.1016/S0015-0282(16)43395-9.

    Article  CAS  PubMed  Google Scholar 

  21. Wagner G, Levin R. Human vaginal pH and sexual arousal. Fertil Steril. 1984;41(3):389–94. https://doi.org/10.1016/S0015-0282(16)47717-4.

    Article  CAS  PubMed  Google Scholar 

  22. Goldstein I, Traish A, Kim N, Munarriz R. The role of sex steroid hormones in female sexual function and dysfunction. Clin Obstet Gynecol. 2004;47(2):471–84. https://doi.org/10.1097/00003081-200406000-00022.

    Article  PubMed  Google Scholar 

  23. Santoro N, Worsley R, Miller KK, Parish SJ, Davis SR. Role of estrogens and estrogen-like compounds in female sexual function and dysfunction. J Sex Med. 2016;13:305–16. https://doi.org/10.1016/j.jsxm.2015.11.015.

    Article  PubMed  Google Scholar 

  24. Davis SR, Worsley R, Miller KK, Parish SJ, Santoro N. Androgens and female sexual function and dysfunction--findings from the fourth international consultation of sexual medicine. J Sex Med. 2016:168–178. https://doi.org/10.1016/j.jsxm.2015.12.033.

  25. Rosenfield RL, Cooke DW, Radovick S. Puberty and its disorders in the female. In: Pediatric Endocrinology. 2014:569–663.e1. https://doi.org/10.1016/B978-1-4557-4858-7.00024-X.

  26. Cohen SD, Goldstein I. Diagnosis and management of female sexual arousal disorder. 2016:251–260. https://doi.org/10.1007/978-1-4939-3100-2_22

  27. Maseroli E, Vignozzi L. Testosterone and vaginal function. Sex Med Rev. 2020;8(3):379–92. https://doi.org/10.1016/j.sxmr.2020.03.003.This paper summarizes pre-clinical and clinical data that shows testosterone plays a critical role in the maintenance of vaginal tissue structure and function.

  28. Mandal S, Mukhopadhyay P, Ghosh S. Sexual dysfunction in Sheehan syndrome. Endocrine Practice. 2021;27(12):1212–5. https://doi.org/10.1016/j.eprac.2021.07.013. This paper evaluated sexual function in women with Sheehan syndrome, a condition marked by necrosis of the pituitary gland and severe androgen deficiency. Sheehan syndrome patients exhibited significantly lower scores in the domains of desire, arousal, lubrication, orgasm, and satisfaction, compared to healthy controls.

  29. Mandal S, Mukhopadhyay P, Ghosh S. DHEA on sexual function in Sheehan syndrome: a randomized double-blind placebo-controlled crossover trial. J Clin Endocrinol Metab. 2022 Apr 27. https://doi.org/10.1210/clinem/dgac260. This crossover trial investigated the effect of DHEA supplementation (25 mg/twice daily) versus placebo on sexual functioning in patients with Sheehan syndrome. The findings suggest that DHEA supplementation improves sexual functioning in the domains of desire, arousal, lubrication, orgasm, and satisfaction.

  30. Hobeika E, Armouti M, Kala HS, Stocco C. Ovarian hormones. In: Hormonal signaling in biology and medicine. Elsevier, 2020:565–583. https://doi.org/10.1016/B978-0-12-813814-4.00025-0.

  31. Nappi RE, Polatti F. Continuing medical education: the use of estrogen therapy in women’s sexual functioning (CME). J Sex Med. 2009;6:603–16. https://doi.org/10.1111/j.1743-6109.2008.01198.x.

    Article  CAS  PubMed  Google Scholar 

  32. Kayisli UA, Basar M, Guzeloglu-Kayisli O, et al. Long-acting progestin-only contraceptives impair endometrial vasculature by inhibiting uterine vascular smooth muscle cell survival. Proc Natl Acad Sci USA. 2015;112:5153–8. https://doi.org/10.1073/pnas.1424814112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. De La Hoz FJ. Effects of combined oral contraceptives on women’s sexual function, Eje Cafetero, Colombia, 2016–2020. J Sex Med Res 2022;102. https://doi.org/10.47363/JSMR/2022. This cross-sectional study investigated sexual functioning among women using combined oral contraceptives. Women taking ethinylestradiol/drospirenone (EE2/DSP) demonstrated decreased arousal and lubrication scores at 9 months; however, this finding was not observed among women taking Estradiol Valerate/Dienogest (VE2/DNG) or ethinylestradiol/levonorgestrel (EE2/LNG).

  34. Aritonang TR, Rahayu S, Sirait LI, Karo MB, Simanjuntak TP, Natzir R, et al. The role of FSH, LH, estradiol and progesterone hormone on estrus cycle of female rats. Int J Sci: Basic Appl Res. 2017;53(1):92–100.

    Google Scholar 

  35. Pessina MA, Hoyt RF, Goldstein I, Traish AM. Differential effects of estradiol, progesterone, and testosterone on vaginal structural integrity. Endocrinology. 2006;147:61–9. https://doi.org/10.1210/en.2005-0870.

    Article  CAS  PubMed  Google Scholar 

  36. Witherby S, Johnson J, Demers L, Mount S, Littenberg B, Maclean CD, Wood M, Muss H. Topical testosterone for breast cancer patients with vaginal atrophy related to aromatase inhibitors: a phase I/II study. Oncologist. 2011;16:424–31. https://doi.org/10.1634/theoncologist.2010-0435.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. McEndree B. Clinical application of the vaginal maturation index. Nurse Pract. 1999;24:48–57.

    Article  CAS  PubMed  Google Scholar 

  38. Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85:87–94. https://doi.org/10.4065/mcp.2009.0413.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Traish AM, Botchevar E, Kim NN. Biochemical factors modulating female genital sexual arousal physiology. J Sex Med. 2010;7(9):2925–46.

    Article  CAS  PubMed  Google Scholar 

  40. Sharma H, Ji E, Yap P, Vilimas P, Kyloh M, Spencer NJ, et al. Innervation changes induced by inflammation in the murine vagina. Neuroscience. 2018;372:16–26. https://doi.org/10.1016/j.neuroscience.2017.12.026.

    Article  CAS  PubMed  Google Scholar 

  41. Hu JM, Cheng X, Wang L, Zhu JN, Zhou LH. Vasoactive intestinal peptide expression in the vaginal anterior wall of patients with pelvic organ prolapse. Taiwan J Obstet Gynecol. 2013;52(2):233–40.

    Article  PubMed  Google Scholar 

  42. Palle C, Bredkjœr HE, Fahrenkrug J, Ottesen B. Vasoactive intestinal polypeptide loses its ability to increase vaginal blood flow after menopause. Am J Obstet Gynecol. 1991;164:556–8. https://doi.org/10.1016/S0002-9378(11)80019-0.

    Article  CAS  PubMed  Google Scholar 

  43. Kim H, Kim SC, Seo K, Lee M. Effects of estrogen on the relaxation response of rabbit clitoral cavernous smooth muscles. Urol Res. 2002;30(1):26–30. https://doi.org/10.1007/s00240-002-0235-8.

    Article  CAS  PubMed  Google Scholar 

  44. Kim SW, Kim NN, Jeong S-J, Munarriz R, Goldstein I, Traish AM. Modulation of rat vaginal blood flow and estrogen receptor by estradiol. J Urol. 2004;172:1538–43. https://doi.org/10.1097/01.ju.0000137744.12814.2e.

    Article  CAS  PubMed  Google Scholar 

  45. Min K, Munarriz R, Kim NM, Choi S, O Connell L, Goldstein I, Traish AM et al. Effects of ovariectomy and estrogen replacement on basal and pelvic nerve stimulated vaginal lubrication in an animal model. J Sex Marital Ther 2003:29:77–84. https://doi.org/10.1080/713847131.

  46. Berman JR, McCarthy MM, Kyprianou N. Effect of estrogen withdrawal on nitricoxide synthase expression and apoptosis in the rat vagina. Urology. 1998;51:650–6. https://doi.org/10.1016/s0090-4295(97)00683-3.

    Article  CAS  PubMed  Google Scholar 

  47. Al-Hijji J, Larsson B, Batra S. Nitric oxide synthase in the rabbit uterus and vagina: hormonal regulation and functional significance. 2000:62:1387–1392.https://doi.org/10.1095/biolreprod62.5.1387

  48. Traish AM, Vignozzi L, Simon JA, Goldstein I, Kim NN. Role of androgens in female genitourinary tissue structure and function: implications in the genitourinary syndrome of menopause. Sex Med Rev. 2018;6:558–71. https://doi.org/10.1016/j.sxmr.2018.03.005.

    Article  PubMed  Google Scholar 

  49. Aversa A, Isidori AM, Spera G, Lenzi A, Fabbri A. Androgens improve cavernous vasodilation and response to sildenafil in patients with erectile dysfunction. Clin Endocrinol. 2003;58(5):632–8. https://doi.org/10.1046/j.1365-2265.2003.01764.x.

    Article  CAS  Google Scholar 

  50. Burrows LJ, Basha M, Goldstein AT. The effects of hormonal contraceptives on female sexuality: a review. J Sex Med. 2012;9(9):2213–23. https://doi.org/10.1111/j.1743-6109.2012.02848.x.

    Article  CAS  PubMed  Google Scholar 

  51. Kennedy TG, Armstrong DT. Induction of vaginal mucification in rats with testosterone and 17β-hydroxy-5α-androstan-3-one. Steroids. 1976;27(3):423–30. https://doi.org/10.1016/0039-128X(76)90061-1.

    Article  CAS  PubMed  Google Scholar 

  52. Westwood FR. The female rat reproductive cycle: a practical histological guide to staging. Toxicol Pathol. 2008;36:375–84. https://doi.org/10.1177/0192623308315665.

    Article  PubMed  Google Scholar 

  53. Sarrel PM. Sexuality and menopause. Obstet Gynecol. 1990;75:26S-35S. https://doi.org/10.1016/S1701-2163(15)30464-3.

    Article  CAS  PubMed  Google Scholar 

  54. Alimi Y, Iwanaga J, Oskouian RJ, Loukas M, Tubbs RS. The clinical anatomy of dyspareunia: a review. Clin Anat 2018:1013–7. https://doi.org/10.1002/ca.23250.

  55. Ninomiya N, Sekiguchi Y. The study of the effectiveness of topical testosterone and estrogen for urinary tract symptoms of GSM. J Sex Med. 2022;19(5):S149. https://doi.org/10.1016/j.jsxm.2022.03.595.

    Article  Google Scholar 

  56. Sarrel PM. Androgen deficiency: menopause and estrogen-related factors. Fertil Steril. 2002;1(77):63–7. https://doi.org/10.1016/s0015-0282(02)02967-9.

    Article  Google Scholar 

  57. Handy AB, Freihart BK, Meston CM. The relationship between subjective and physiological sexual arousal in women with and without arousal concerns. J Sex Marital Ther. 2020;46(5):447–59. https://doi.org/10.1097/00003081-200406000-00022.

    Article  PubMed  Google Scholar 

  58. Handy AB, Stanton AM, Pulverman CS, Meston CM. Differences in perceived and physiologic genital arousal between women with and without sexual dysfunction. J Sex Med. 2018;15:52–63. https://doi.org/10.1016/j.jsxm.2017.11.009.

    Article  PubMed  Google Scholar 

  59. Laan E, Van Driel EM, Van Lunsen RH. Genital responsiveness in healthy women with and without sexual arousal disorder. J Sex Med. 2008;5(6):1424–35. https://doi.org/10.1111/j.1743-6109.2008.00827.x.

    Article  PubMed  Google Scholar 

  60. Stone A, Gamble CJ. The quantity of vaginal fluid. Am J Obstet Gynecol. 1959;78:279–81. https://doi.org/10.1016/0002-9378(59)90173-5.

    Article  CAS  PubMed  Google Scholar 

  61. Godley MJ. Quantitation of vaginal discharge in healthy volunteers. BJOG: Int J O&G 1985:92:739–742. https://doi.org/10.1111/j.1471-0528.1985.tb01457.x.

  62. Preti G, Huggins GR, Silverberg GD. Alterations in the organic compounds of vaginal secretions caused by sexual arousal. Fertil Steril. 1979;32:47–54. https://doi.org/10.1016/S0015-0282(16)44115-4.

    Article  CAS  PubMed  Google Scholar 

  63. Wagner G. Vaginal transudation. In: F. K. Beller & G. F. B. Schumacher, editors. The biology of the fluids of the female genital tract: workshop conference in Murnau, Bavaria, June 11–13. Elsevier North Holland; 1979.

  64. Riley AJ, Riley EJ. Cholinergic and adrenergic control of human sexual responses. In: Wheatley D, editor. Psychopharmacology and sexual disorders. Oxford University Press; 1983. p. 125–37.

    Google Scholar 

  65. Carranza-Lira S, Fragoso-Dı́az N, MacGregor-Gooch AL, Garduño-Hernández MP, Rı́os-Calderón K, Aparicio H. Vaginal dryness assessment in postmenopausal women using pH test strip. Maturitas 2003:45:55–58. https://doi.org/10.1016/s0378-5122(03)00082-3.

  66. Dawson SJ, Sawatsky ML, Lalumiere ML. Assessment of introital lubrication. Arch Sex Behav. 2015;44(6):1527–35. https://doi.org/10.1007/s10508-015-0519-z.

    Article  PubMed  Google Scholar 

  67. Gáspár M, Benkő Zs, Dogossy G, Réczey K, Czigány T. Reducing water absorption in compostable starch-based plastics. Polym Degrad Stab 2005:90:563–569. https://doi.org/10.1016/j.polymdegradstab.2005.03.012.

  68. Handy AB, & Meston CM. 028 A novel technique for assessing vaginal lubrication. J Sex Med 2018:15(6):S108–S109. https://doi.org/10.1016/j.jsxm.2018.03.039

  69. Sall K, Stevenson OD, Mundorf TK, Reis BL. CsA Phase 3 Study Group. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. Ophthalmology. 2000;107(4):631–9. https://doi.org/10.1016/s0161-6420(99)00176-1

  70. Lindemann J, Tsakiropoulou E, Rettinger G, Gutter C, Scheithauer MO, Picavet V, Sommer F. The intranasal Schirmer test: a preliminary study to quantify nasal secretion. Eur Arch Otorhinolaryngol. 2014;271:2963–7. https://doi.org/10.1007/s00405-014-2988-4.

    Article  PubMed  Google Scholar 

  71. Wróbel-Dudzińska D, Kubik-Komar A, Rykwa D, Kosior-Jarecka E, Żarnowski T, Chałas R. The use of Schirmer strips to measure salivary and lacrimal flow in non-Sjögren patients. Clin Oral Invest. 2021;25(6):4107–14. https://doi.org/10.1007/s00784-020-03741-3.

    Article  Google Scholar 

  72. Sawatsky ML, Dawson SJ, Lalumière ML. Genital lubrication: a cue-specific sexual response? Biol Psychol. 2018;134:103–13. https://doi.org/10.1016/j.biopsycho.2018.02.003.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. McLean Hospital/Harvard Medical School, Boston, USA

    Ariel B. Handy

  2. Department of Psychology, The University of Texas at Austin, 108 East Dean Keeton Street, Stop A8000, Austin, TX, 78712, USA

    Leah N. McMahon & Cindy M. Meston

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  1. Ariel B. Handy
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Handy, A.B., McMahon, L.N. & Meston, C.M. Local Responses to Genital Arousal — Mechanisms of Lubrication. Curr Sex Health Rep 14, 247–253 (2022). https://doi.org/10.1007/s11930-022-00350-x

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