Fisiología de la respuesta sexual femenina: actualización

Human sexual response includes a variety of psychological, neurophysiological, vascular, and hormonal changes associated to sexual behavior. Knowledge on the physiological mechanism underlying sexual arousal and orgasm in women has grown substantially in recent years. Several intercellular messengers mediating the arousal-related changes in the clitoris and the vagina have been identified (NO, VIP, PGE). Ongoing studies are testing their potential therapeutic implications. New actions of estrogenic hormones on the vaginal epithelium have been documented. Thus, estrogens stimulate both hydrogen pumping by basal cells and their fluid transfer capacity. They both help to explain the important role of estrogens in vaginal function. Functional neuroimaging techniques are been increasingly used to assess the cerebral correlates of women's sexual response. They show that sexual arousal and orgasm associate to increased activity in brain structures such as the anterior cingulate, the insula/claustrum, and caudate/accumbens nuclei and several neocortical areas. Whereas these changes are similar to those reported in men, there are sex-related differences in some areas as the hypothalamus and the amygdala suggestive of a differential processing of sexual stimuli. Despite substantial progress there are still several issues deserving further study. They range from the gross anatomy of the vulva (such as the continuity, or lack of it, of the bulbs and glans clitoris) to the want of a better definition of the physiological role of androgens in women's sexual response.