Coitus

Original Author: Suzannah Fleming
Last Updated: 15th July 2017
Revisions: 5

Coitus and conception are the initial stages that occur in humans that allow for the establishment of pregnancy. Sexual intercourse that results in the deposition of sperm in the vagina at the level of the cervix is known as coitus. In order for coitus to occur humans need to be sexually aroused. Sexual arousal is then followed by a series of phases. These phases are the excitement phase, plateau phase, orgasmic phase and resolution phase.

In this article we shall look at the various phases of coitus and some clinical conditions.

Male Sexual Response

The changes that occur to allow coitus involve genital and systemic alterations in both sexes. The first part of sexual stimulation in a male results in the production of an erection. An erection may be produced due to psychogenic or somatogenic stimuli; this means it may be caused by stimulation of efferent nerves to the penis via the limbic system in the brain due to sensory cues such as images or it may be via somatogenic stimuli such as touching the penis.

The plateau phase in males results in an increase in the penile erection, increase in size of testicles and a rise in heart rate and blood pressure.

Following on from the plateau phase there is the orgasmic phase. Firstly, several structures contract in order to mix the contents of the ejaculate and this is called emission. The second part of the orgasmic phase is ejaculation and is the result of muscular contractions to expel semen from the prostatic urethra.

The final part of the sexual response cycle is the resolution phase and in males this is split into two stages. The first stage results in the penis reducing from full erection to 50% larger than its unstimulated size and the second, longer phase, results in the penis reducing to its normal unstimulated size. Below is a table summarising the stages in the male:

Males Nervous system stimulated Consequence
Coitus
Excitement phase Sacral parasympathetic neurons Arteriolar vasodilation in corpora cavernosa which increases penile blood flow

Penile filling (latency)

Penile tumescence (erection)

Plateau phase Sacrospinous reflex Contract ischiocavernosus

Venous engorgement and decreased arterial inflow

Testes become completely engorged and elevated

Stimulate secretion from accessory glands which will make up 5% of ejaculate

Lubricate distal urethra, neutralise acidic urine in urethra

Orgasmic phase Emission Thoracolumbar sympathetic reflex Contract smooth muscles in ductus deferens, ampulla, seminar vesicle and prostate

Internal and external urethral sphincters contract

Semen pooled in urethral bulb

Ejaculation Spinal reflex with cortical control (L1,L2 sympathetic) Contract glands and ducts

Contract urethral sphincter

Filling of internal urethra stimulates pudendal nerve which contracts genital organs, ischiocavernosus and bulbocavernosus resulting in expulsion of semen

Resolution phase Thoracolumbar sympathetic pathway Contraction of arteriolar smooth muscle in corpora cavernosa

Increased venous return leads to detumescence flaccidity which results in refractory period

Fig 1 – Summary of the male phases of coitus

Female Sexual Response

The autonomic nervous system that controls the four parts of coitus is the same in males and females however the responses of the genital organs are different.

Within females, the excitement phase results in anatomical changes that increase the circumference of the vaginal diameter at the level of the pelvis and lubricate the vagina for penile entry.

Following the excitement phase, the plateau phase results in the labia minora becoming red in appearance as well as the respiratory rate, heart rate and blood pressure increasing.

Within females, the orgasmic phase does not include emission and ejaculation. The orgasm includes contraction of the lower third of the vagina and can extend to whole vagina and uterus. The final phase of resolution encompasses several changes that result in the return of the structures to normal unstimulated states. Below is a table summarising the changes in the female.

Females Nervous system stimulated Consequence
Coitus
Excitement phase Sacral parasympathetic neurons Vasocongestion

Vaginal lubrication

Clitoris engorges with blood

Uterus elevates

Increase in muscle tone, heart rate and BP

Inner two-thirds of vagina lengthens and expands

Plateau phase Sacrospinous reflex Further increase in muscle tone, heart rate and BP

Labia minora deepends in colour

Clitoris withdraws under hood

Bartholin gland secretion in order to lubricate vestibule for entry of penis

Uterus fully elevated and organismic platform forms in lower one third of vagina

Orgasmic Spinal reflex with cortical control (L1,L2 sympathetic) Orgasmic platform contracts rhythmically 3-15 times

Uterus contracts, anal sphincter contracts

Resolution phase Thoracolumbar sympathetic pathway Clitoris descends and engorgement subsides

Labia return to unaroused colour and size

Uterus descends to unaroused position

Vagina shortens and narrows back to unaroused state

No refractory period and so multiple orgasms are possible

Table 2 – Summary of the female phases of coitus

Male Vs Female Sexual Response

There are several differences in the physiological sexual response of males and females:

  • Emission and ejaculation do not occur in the female
  • Females are capable of several orgasms and the orgasm may last relatively longer than that of a male
  • Females are able to reach the plateau phase and sustain it then return to an unstimulated state without orgasm

Clinical Relevance – Ageing and the sexual response

There are several changes that occur in females as a result of ageing:

  • Reduced vasocongestion response, causing reduced vaginal lubrication
  • Vaginal and urethral tissue lose elasticity
  • Length and width of vagina decrease which reduces the expansile ability of inner vagina during arousal
  • Number of orgasmic contractions is often reduced
  • More rapid resolution

Clinical Relevance – Sexual dysfunction

Sexual dysfunction can be caused by a change in desire or arousal. The most common type of sexual dysfunction is when there is a problem with desire. Below are several types of sexual dysfunctions caused by an abnormality in desire:

  • Hypoactive- little of no interest in sex
  • Aversion- revulsion or fear of sex
  • Hyperactive
  • Nymphomaniac
  • Kluver Bucci syndrome

When the arousal stage is abnormal in females this is due to a lack of ability to maintain or attain the lubrication response and is often seen in menopause. In males, a problem with arousal is called impotence. Impotence can be caused by descending inhibition of spinal reflexes due to psychological problems, tears in fibrous tissue of corpora cavernosa, vascular abnormalities (atherosclerosis and diabetes) and certain drugs. Viagra can be prescribed for males and works by inhibiting cGMP breakdown and results in an increased nitric oxide action that produces an erection.

Sperm abnormalities may be another reason for sexual dysfunction and this could be a low level of sperm within the ejactulate (oligoospermia) or sperm morphological defects.

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