The Female Sexual Response Cycle

Clitoris…engorgement…cervix…introitus…there, now your brain can get past the distracting awkwardness and we can move on to the content of the article.

So we’re all well aware that the female sexual response is a bit more complicated than say, the typical male's sexual responses. I’ve had numerous women use the saying “all the stars have to align for me to…”, I’ll let your head fill in the rest of that sentence. But what are all these “stars” and what is this “alignment”?

First let’s break apart the Female Sexual Response Cycle into 4 phases:

1. Arousal Phase

2. Plateau Phase

3. Climax Phase

4. Resolution Phase

To enter Phase 1- arousal, we need a little background information. Let’s start at the top, up in the brain. The brain, along with the spinal cord and neural ganglia, control what’s called our autonomic nervous system. If you’ve ever heard of the

“fight or flight” - the sympathetic mode

And

“rest and digest” - the parasympathetic mode

… they are both parts of the autonomic nervous system (ANS).

The ANS goal is to keep your body responding appropriately to the environment you’re in. For example: if you were hiking and a bear started chasing you, your ANS prioritizes increasing your heart rate and shuttling blood to your extremities to help you run faster. However, it does not prioritize proper bladder/bowel functioning at that moment, which is why you may soil your pants in the process.

In order for the brain to send a signal for sexual arousal to occur, a person needs to be in a parasympathetic mode. This is why cuddling, hugging, feelings of safety, trust, and excitement will result in a sexual encounter more frequently than say a long, stressful day, rushing into the activity, or if anxiety levels are high.

When a female is in a resting state, the vaginal walls are closed. Once an appropriate stimulus occurs and the Arousal Phase has begun…the clitoris, surrounding pelvic floor muscles and tissues begin to fill with blood. The engorgement, or swelling of these tissues increases sensitivity of the region. Internal muscular contractions begin to stimulate the vagina, resulting in vaginal tenting. Vaginal tenting is when the cervix and uterus pull up and back, creating more space inside the vaginal canal, which allows the vagina to receive an object internally. Without this tenting, it could feel like the object is hitting a wall, rather than gliding smoothly.

Now, what’s interesting is the location of the cervix also changes depending on where in the menstrual cycle the female currently stands. For example, during ovulation, the cervix rises higher, to the top of the vagina and softens, increasing fertility. Shortly after ovulation the cervix begins to move back down, with its lowest position being during menses. The cervix actually stays just slightly open during these few days, to allow menstrual blood to flow out. The cervix is also positioned higher, toward the top of the vagina, and remains soft + closed when a female is pregnant, until it is time to give birth. The human body is incredible!

Okay, so phase one quickly turns into phase two now that blood flow has started to fill the tissues, vaginal tenting and lengthening has occurred, resulting in a lifted cervix.

Phase Two: The Plateau Phase is composed of continued blood flow to the pelvic region and genitals. Glands of the vagina secrete lubricating fluid. Additionally, breathing, heart rate, and blood pressure increase, signaling that the nervous system is shifting into a sympathetic response, preparing for phase three.

In medical terms Phase Three - The Climax, is the release of build up tension resulting in a pleasurable spasming of the pelvic muscles. The body releases hormones, such as oxytocin and dopamine that make the individual feel happy, relaxed, and bonded. It is this phase that many people can recognize the benefits of completing pelvic floor therapy.

For example, let’s say after you’ve had a child, or a few, you notice that reaching climax is more difficult. Or when you are able to climax, it’s just not as pleasurable as it used to be. Oftentimes upon examination, a poor length-tension relationship is present in the pelvic floor muscles. This means, there’s either too much resting tension or not enough, thus when the muscles spasm they’re not as “strong” as they have the potential to be. This can also occur in men and typically will present as either premature ejaculation, or pain during/after ejaculation. A pelvic floor therapist can assess whether the pelvic floor muscles could benefit from improving mobility or strength of these tissues and instruct the client in exercises to address these limitations. Clients typically provide feedback in which they gratefully report a stronger, more pleasurable interaction with their partner.

The final phase- The Resolution, is fairly obvious. The muscles stop spasming and relax, as those feel good hormones are coursing through the body to guide it back into a parasympathetic state of being.

The chart below does its best to summarize some of the signals that have to take place between the nervous system and the rest of the body.

However, as complex as it looks, this is a simplified chart. There are numerous variables that may impact sexual function including pain with past penetration, hormonal changes, mental health issues, stress, relationship dynamics, religious belief conflicts, history of abuse/sexual trauma, medical conditions. So yes, many “stars have to align”, but if you’re struggling and haven’t yet had your pelvic floor muscles assessed, you may be missing out on a key aspect holding you back from those pleasurable experiences.

If you, or a loved one, could benefit from learning more on this topic, please reach out to Dr. Mariah Lohr PT, DPT, PRPC at nomadicphysicaltherapy@gmail.com