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Question: What characterizes normal sexual function in women?
Normal sexual function is characterized by: Four pillars - it is characterized by desire an arousal and excitement phase, adequate lubrication, and orgasm. The sexual response is actually four stages – excitement, plateau, orgasm, and resolution.

1. In stage 1

Excitement, this stage can last anywhere from a few minutes to several hours.  Sexual activity during this stage is often called foreplay. Extending foreplay can sometimes make the other stages more intense. In the excitement phase, the blood flow to the genitals increases, and the clitoris swells. The vagina begins to lubricate, and creates the natural vaginal moisture. The blood flow to a woman's breasts increases and her nipples may get hard or erect, and her heart rate and blood pressure increases, and breathing may speed up.

2. Stage 2  

is the Plateau stage. During this stage, due to the increase in blood flow, the outer third of the vagina and the genitals appear darker, the clitoris is very sensitive, and may retract beneath its hood, and the increase in heart rate, blood pressure, and breathing
continues. Muscle tension increases, and spasm may occur in even the feet, the face, and the hands.

3. In stage 3  

Orgasm, this is the climax. The muscles in the outer third of the vagina contract in a rapid sequence. The first contractions are the most intense and closest
together. The muscles in the uterus also contract. The heart rate, blood pressure, and breathing are at higher rates. The skin may appear red or flushed. Orgasm is actually theshortest of the four stages, and usually, it is measured in seconds.

4. Stage 4  

is the Resolution or relaxation stage. During this stage, a woman's clitoris and nipples get soft again. The vagina and genitals return to their normal size and contour, and the breathing rate, heart rate, and blood pressure decreases. In this resolution stage, women may return to the plateau stage and orgasm again.

When we are talking about normal sexual function, we have to note that in women, we are more complex than men. Let's face it.

Men basically need three things for contentment within a relationship:

1. They need an occupation.
2. They need to feel like they are put on a pedestal.
3. They need sex.

Women are much more complex than that! There are many things that are going on that have to be taken care of for us to have a continually healthy sexual relationship. We need good health and hormonal balance. A woman needs to feel comfortable in her body and confidence in her ability to communicate what she wants. A woman needs to be in the moment, for example, have left the grocery list behind, focusing on the touch, intimacy and sensuality of the moment. This is called sensate focus. A woman also needs to feel a physical and emotional connection to her partner, and that needs to be nurtured. Sensual massage is an excellent way to nurture that, and to feel what each partner enjoys. Again, being comfortable with your body, and being able to communicate and take charge of your satisfaction, both with your partner, and through selfstimulation, being creative, trying different positions, especially if there is dyspareunia or pain
with intercourse.

Another key ingredient to sexual satisfaction is hormonal balance, decreasing inflammation, and general physical health. When I treat a woman, for example, with a decreased libido who does have difficulties with the sexual response, we look at a comprehensive picture, encompassing the mind and the spirit, a healthy relationship and communication with her partner, good diet, nutrition, and exercise, and by diet, I mean protein at every meal. I always emphasize good diet with patients, including fatty acids, good omega 3's, which help with dopamine, decrease inflammation, and improve circulation. I encourage a low glycemic load diet, because too many carbohydrates can actually increase/overstimulate your serotonin, and decrease your desire to have sex. So a balanced diet with high quality protein, rich in essential fatty acids, quality fiber, and lots of green vegetables, especially broccoli, cauliflower, brussel sprouts, which help to detoxify estrogens, and avoiding starches and sugars contribute to overall vitality. I tell patients, if they can pick it, peel it, fish it, hunt it, milk it, grow it, then for the most part, they can eat it!

Processed foods add to our toxic burden. It is beneficial to eat as much free range and organic foods as possible, because we ingest xenoestrogens (substances that act like estrogens and bind to estrogen receptors) in foods from pesticides and herbicides and hormones that are in our foods. Therefore, low toxic load, healthy detoxification, healthy hormone balance.

Stay tuned, in the next blog we will discuss female sexual problems.  There is also more information on my website, and I am available for consultations.
Best wishes for health, peace, and happiness,
Anna Cabeca, DO, FACOG, DAARM


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