What Is The Sexual Response Cycle?

  • Lydia Lyratzopoulos Biomedical Science, University of Bristol, UK
  • Jessica Tang BSc, Cancer Science, Oncology and Cancer Biology, University of Nottingham

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Introduction

The sexual response cycle is a model composed of four different phases which reflect the emotional and physical changes that occur during sexual intercourse. 

The stages of the sexual response cycle are as follows:1

  • Excitement
  • Plateau
  • Orgasm
  • Resolution

Importance of understanding the sexual response cycle

Understanding the sexual response cycle allows us to understand the physiology and psychology of sexual intercourse. This cycle also allows us to understand sexual dysfunction, which can help physicians diagnose sex-related issues. 

Four stages of the sexual response cycle

Excitement phase

Physical changes

During the excitement phase, people assigned male at birth (AMAB) and people assigned female at birth (AFAB) experience an increase in heart rate and muscle tension. There is also increased blood flow, causing flushing and increased blood flow to the genital area. This causes a penile erection in people assigned male at birth. Additionally, in people with AMAB, the scrotum, which holds the testicles, begins to tighten, and the Cowper’s glands may begin to secrete pre-ejaculatory fluid. In people with AFAB, vaginal lubrication may begin at this stage, and the nipples may become hard.1

Role of arousal and anticipation

Arousal via physical contact such as touching and kissing, or possibly thoughts can result in the physical changes that prepare the body for sexual intercourse.1

Variability in individual experiences

During the excitement stage, individuals may feel emotional and physical changes to different degrees of intensity. It has also been reported that many people with AFAB do not go through the phases of the sexual response cycle in order.

Plateau phase

Continued physical arousal results in the physical changes observed during the excitement phase becoming more intensified. For women, the vagina may begin to swell due to increased blood flow, and the women’s clitoris becomes highly sensitive to touch. This touch may even be painful for some women, resulting in the clitoris retracting under the clitoral hood to avoid any direct stimulation, which may elicit pain. For men, the testicles will continue to tighten as they did during the excitement phase.2

Increased heart rate and breathing

Both sexes will experience an increase in heart rate and breathing rate. There may also be an increase in blood pressure.2

Orgasm phase    

The orgasm phase is the climax of the sexual response cycle, with the shortest duration, usually only lasting a few seconds.

Intense pleasure and release of sexual tension

During the orgasm phase, the individuals involved will experience a sudden release of built-up sexual tension from the excitement and plateau phases. There may be muscle spasms in the feet during this release of sexual tension. At this stage in the sexual response cycle, sexual satisfaction has been reached.

Physiological changes during orgasm

Both sexes experience the highest rate of breathing and heart rate during this stage of the sexual response cycle. There may also be a flush on the skin due to high blood flow.

Differences in orgasms between sexes 

During an orgasm for women the muscles in the vagina contract, and there may also be contractions of the uterus. In comparison, for men, there are contractions at the base of the penis, resulting in the ejaculation of semen.

Resolution phase

Return to pre-arousal state

During the resolution phase, any parts of the body which are erect, such as the penis, will return to their normal size and state. In addition, any swelled parts of the body will also return to their natural state and colour, such as the clitoris.

The refractory period in people AMAB

Whilst people with AFAB may experience multiple orgasms, some of which may be back-to-back, this is not the case for males. Males have a recovery period termed the refractory period, where they can not orgasm again. This period varies amongst individuals and may also vary with age. 

It has been suggested that the refractory period in males is needed to allow their sperm count to reach an adequate level to impregnate a female.2

Emotional and psychological changes post-orgasm

After the orgasm phase, both parties usually experience feelings of satisfaction. However, there are circumstances where individuals report negative feelings, such as depression, anxiety, and possibly aggression after sexual intercourse. This is known as postcoital dysphoria, which is a rare psychiatric disorder that affects women more than men.3

Factors influencing the sexual response cycle

Emotional and psychological factors

  1. Stress and anxiety

Chronic stress activates a part of the nervous system known as the sympathetic nervous system, which is responsible for the flight or fight response in the body. When the sympathetic nervous system is activated, less blood flows to the genital area, which can result in less stimulation during the excitement phase of the sexual response cycle. This can stop an individual from progressing through the stages of the human sexual response cycle as a result.4

  1. Relationship dynamics

Emotional intimacy in a relationship is important in maintaining sexual desire, which is needed to progress through the stages of the human sexual response cycle.5

  1. Body image and self-esteem

Body image is the attitude you have towards your own body. If you are dissatisfied with your body’s appearance, this can hinder the sexual experience, making sexual pleasure less likely. Both males and females who have a positive attitude towards their body’s appearance experience better sexual performance and are more likely to go through all four phases of the sexual response cycle.6

  1. Physical factors

Hormones and their role

Testosterone plays a role in sexual desire, particularly in males, being produced in the testes. Females also produce a small amount of testosterone, which comes from the ovaries and the adrenal glands. Lower amounts of testosterone can be associated with lower sexual desire and arousal, stopping an individual from progressing through the stages of the sexual response cycle.

  1. Medications and their impact

It has been reported that over-the-counter antihistamines may result in erectile dysfunction, preventing an individual from acting on their sexual desire and progressing through the stages of the sexual response cycle. Anti-hypertensive medications, which treat high blood pressure, may also cause erectile dysfunction. Decreased sexual desire has also been reported in those who take antidepressants, such as selective serotonin reuptake inhibitors (SSRIs). These side effects have been reported in both males and females.7

Health conditions affecting sexual response

Certain conditions can affect sexual function and consequently influence the sexual response, such as the following:

  • Diabetes
  • Heart disease
  • Blood vessel disease
  • Neurological disorders
  • Liver failure
  • Kidney failure

Sociocultural factors

  1. Cultural norms and taboos

In many religions, religious beliefs, the patriarchy and traditions can influence sexuality, particularly for a woman. In certain parts of the world, there is a lack of education for women about sexual pleasure and desire and even knowledge of their bodies. Ultimately, female sexual pleasure can be seen as taboo. On the other side of the coin, in less non-traditional parts of the world, social media dictates how women learn about sexual pleasure and view sexuality. However, this can have negative impacts on both male's and female's self-esteem and how they view their bodies.8

In conservative cultures, a woman may protect her virginity until marriage, and not be expected to have premarital sex as this can disgrace the family and make her undesirable for marriage.8

  1. Social expectations and peer influence

There are double standards regarding the social expectations of men's and women’s sex lives. Men are often regarded as being “a stud” if they have multiple sexual partners, whereas for women having multiple sexual partners is frowned upon.9

Common sexual dysfunctions

Erectile dysfunction

Erectile dysfunction affects males and results in them not being able to get an erection that is firm enough for sexual intercourse to take place. This condition mainly affects men aged 40-70. There is a reported symptom of reduced sexual desire because of erectile dysfunction, which may prevent an individual from experiencing the excitement phase of the human sexual response cycle and later phases, too.

Premature ejaculation

Premature ejaculation is when a male ejaculates sooner than expected during sexual intercourse. Premature ejaculation can be a lifelong condition or acquired after an individual has had previous sexual experiences. It may cause an individual to not fully enjoy all the phases of the sexual response cycle and may put them off having sexual intercourse.

Female sexual arousal disorder

Female sexual arousal disorder occurs when the female’s body does not respond to sexual stimulation and may result in less sexual desire, preventing the individual from reaching the excitement phase. The orgasm phase of the human sexual response cycle may also not be reached.

Anorgasmia

Anorgasmia is when orgasms are delayed, infrequent or completely absent from the sexual experience, causing an individual not to reach the orgasm phase of the sexual response cycle. Physical conditions and certain medications can cause this condition.

Communication and education

Importance of open communication about sexual response

Being open with your partner about the sexual response can increase the chances of sexual satisfaction. However, many individuals find it uncomfortable to talk about the sexual response.10

The role of sexual education in promoting healthy sexual functioning

Sexual education allows individuals to access valid health information and products which promote healthy sexual functioning. It also allows individuals to take responsibility for their sexual health, and how to make informed decisions about sex.11

Encouraging safe and consensual sexual experiences

Communicating about having safe sex and getting tested for sexually transmitted infections is important when remaining safe during sex. Consent is also important for both parties to ensure that no one is pressured into a sexual situation they do not want to be in.12

Summary

  • The stages of the sexual response cycle were coined by Masters and Johnson (1966)
  • The stages of the sexual response cycle are the excitement phase, plateau phase, orgasm phase and the resolution phase.
  • Certain conditions and medications may prevent individuals from experiencing some of the phases in the sexual response cycle.
  • Addressing sexual health can prevent sexually transmitted infections 
  • Certain parts of the sexual response cycle are not fully understood, such as the refractory period for males after the orgasm phase

References:

  1. R DRS. What Is the Sexual Response Cycle? [Internet]. 2022 [cited 2024 Mar 18]. Available from: https://www.icliniq.com/articles/sexual-health/sexual-response-cycle.
  2. What Are the Four Phases of the Sexual Response Cycle? MedicineNet [Internet]. [cited 2024 Mar 18]. Available from: https://www.medicinenet.com/four_phases_of_the_sexual_response_cycle/article.htm.
  3. Sachdeva N, Suresh V, Zeeshan M, Kamaraj B, Mehdi A. A case report of postcoital dysphoria: a paradoxical melancholy. Cureus [Internet]. [cited 2023 Oct 13];14(10):e30746. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9700232/
  4. Hamilton LD, Meston CM. Chronic stress and sexual function in women. J Sex Med [Internet]. 2013 Oct [cited 2023 Oct 13];10(10):2443–54. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199300/
  5. van Lankveld J, Jacobs N, Thewissen V, Dewitte M, Verboon P. The associations of intimacy and sexuality in daily life. J Soc Pers Relat [Internet]. 2018 May [cited 2023 Oct 13];35(4):557–76. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987853/
  6. Potki R, Ziaei T, Faramarzi M, Moosazadeh M, Shahhosseini Z. Bio-psycho-social factors affecting sexual self-concept: A systematic review. Electron Physician [Internet]. 2017 Sep 25 [cited 2023 Oct 13];9(9):5172–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633209/
  7. Higgins A, Nash M, Lynch AM. Antidepressant-associated sexual dysfunction: impact, effects, and treatment. Drug Healthc Patient Saf [Internet]. 2010 Sep 9 [cited 2023 Oct 13];2:141–50. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108697/
  8. Atallah S, Redón AM. Relevant (Sexual) aspects of cultural differences. In: Geuens S, Polona Mivšek A, Gianotten WoetL, editors. Midwifery and Sexuality [Internet]. Cham: Springer International Publishing; 2023 [cited 2023 Oct 13]. p. 271–81. Available from: https://doi.org/10.1007/978-3-031-18432-1_23
  9. Endendijk JJ, Van Baar AL, Deković M. He is a stud, she is a slut! A meta-analysis on the continued existence of sexual double standards. Pers Soc Psychol Rev [Internet]. 2020 May [cited 2023 Oct 13];24(2):163–90. Available from: http://journals.sagepub.com/doi/10.1177/1088868319891310
  10. Sexual Communication with a Partner | BCM [Internet]. [cited 2024 Feb 19]. Available from: https://www.bcm.edu/research/research-centers/center-for-research-on-women-with-disabilities/a-to-z-directory/sexual-health/sexual-communication-with-a-partner.
  11. What Works In Schools: Sexual Health Education | DASH | CDC [Internet]. 2023 [cited 2024 Feb 19]. Available from: https://www.cdc.gov/healthyyouth/whatworks/what-works-sexual-health-education.htm.
  12. Sexual Communication & Consent | Health Promotion & Wellness [Internet]. [cited 2024 Feb 19]. Available from: https://wellness.sfsu.edu/sexual-communication-consent#:~:text=Open%20communication%20with%20your%20sexual,the%20spread%20of%20STI%2FSTD.

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