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The human sexual response cycle is a four-stage model of physiological responses to sexual stimulation, which, in order of their occurrence, are the
excitement Excitation, excite, exciting, or excitement may refer to: * Excitation (magnetic), provided with an electrical generator or alternator * Excite Ballpark, located in San Jose, California * Excite (web portal), web portal owned by IAC * Electron e ...
, plateau, orgasmic, and resolution phases. This physiological response model was first formulated by William H. Masters and Virginia E. Johnson, in their 1966 book ''Human Sexual Response''.Masters & Johnson ''Human Sexual Response'', Bantam, 1981 ; 1st ed. 1966 Since that time, other models regarding human sexual response have been formulated by several scholars who have criticized certain inaccuracies in the human sexual response cycle model.


Excitement phase

The excitement phase (also known as the arousal phase or initial excitement phase) is the first stage of the human sexual response cycle, which occurs as a result of physical or mental erotic stimuli, such as
kiss A kiss is the touch or pressing of one's lips against another person or an object. Cultural connotations of kissing vary widely. Depending on the culture and context, a kiss can express sentiments of love, passion, romance, sexual attraction, ...
ing,
making out Making out is a term of American origin dating back to at least 1949, and is used to refer to kissing, including extended French kissing or heavy kissing of the neck (called ''necking''), or to acts of non-penetrative sex such as heavy pett ...
, fantasizing or viewing erotic images, that leads to
sexual arousal Sexual arousal (also known as sexual excitement) describes the physiological and psychological responses in preparation for sexual intercourse or when exposed to sexual stimuli. A number of physiological responses occur in the body and mind a ...
. During this stage, the body prepares for
sexual intercourse Sexual intercourse (or coitus or copulation) is a sexual activity typically involving the insertion and thrusting of the penis into the vagina for sexual pleasure or reproduction.Sexual intercourse most commonly means penile–vaginal pene ...
, initially leading to the plateau phase. There is wide socio-cultural variation regarding preferences for the length of foreplay and the stimulation methods used. Physical and emotional interaction and stimulation of the erogenous zones during foreplay usually establishes at least some initial arousal.


Excitement in both sexes

Among both sexes, the excitement phase results in an increase in heart rate, breathing rate, and a rise in
blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure ...
. A survey in 2006 found that sexual arousal in about 82% of young females and 52% of young males arises or is enhanced by direct
stimulation of nipples Nipple stimulation or breast stimulation is stimulation of the breast. Stimulation may be by breastfeeding, sexual activity, or an indirect non-sexual response. As part of sexual activity, the practice may be performed upon, or by, people of any ...
, with only 7–8% reporting that it decreased their arousal. Vasocongestion of the skin, commonly referred to as the
sex flush Flushing is to become markedly red in the face and often other areas of the skin, from various physiological conditions. Flushing is generally distinguished, despite a close physiological relation between them, from blushing, which is milder, gen ...
, will occur in approximately 50-75% of females and 25% of males. The sex flush tends to occur more often under warmer conditions and may not appear at all under cooler temperatures. During the female sex flush, pinkish spots develop under the breasts, then spread to the breasts, torso, face, hands, soles of the feet, and possibly over the entire body. Vasocongestion is also responsible for the darkening of the clitoris and the walls of the vagina during sexual arousal. During the male sex flush, the coloration of the skin develops less consistently than in the female, but typically starts with the epigastrium (upper abdomen), spreads across the chest, then continues to the neck, face, forehead, back, and sometimes, shoulders and forearms. The sex flush typically disappears soon after orgasm occurs, but this may take up to two hours or so and, sometimes, intense sweating will occur simultaneously. The flush usually diminishes in reverse of the order in which it appeared. An increase in muscle tone (
myotonia Myotonia is a symptom of a small handful of certain neuromuscular disorders characterized by delayed relaxation (prolonged contraction) of the skeletal muscles after voluntary contraction or electrical stimulation. Myotonia is the defining symp ...
) of certain muscle groups, occurring voluntarily and involuntarily, begins during this phase among both sexes. Also, the external anal sphincter may
contract A contract is a legally enforceable agreement between two or more parties that creates, defines, and governs mutual rights and obligations between them. A contract typically involves the transfer of goods, services, money, or a promise to tr ...
randomly upon contact (or later during
orgasm Orgasm (from Greek , ; "excitement, swelling") or sexual climax is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic, involuntary muscular contractions in the pelvic region chara ...
without contact).


Excitement in males

In males, the beginning of the excitement phase is observed when the
penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males d ...
becomes partially or fully erect, often after only a few seconds of erotic stimulation. The erection may be partially lost and regained repeatedly during an extended excitement phase. Both
testicle A testicle or testis (plural testes) is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testoste ...
s become drawn upward toward the
perineum The perineum in humans is the space between the anus and scrotum in the male, or between the anus and the vulva in the female. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), includi ...
, notably in
circumcised Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. Topic ...
males where less skin is available to accommodate the erection. Also, the
scrotum The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum co ...
can tense and thicken during the erection process.


Excitement in females

In females, the excitement phase can last from several minutes to several hours. The onset of vasocongestion results in swelling of the woman's clitoris, labia minora and vagina. The muscle that surrounds the vaginal opening grows tighter and the uterus elevates and grows in size. The vaginal walls begin to produce a lubricating organic liquid. Meanwhile, the breasts increase slightly in size and nipples become hardened and erect.


Plateau phase

The plateau phase is the period of sexual excitement prior to
orgasm Orgasm (from Greek , ; "excitement, swelling") or sexual climax is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic, involuntary muscular contractions in the pelvic region chara ...
. The phase is characterised by an increased circulation and heart rate in both sexes, increased sexual pleasure with increased stimulation and further increased muscle tension. Also, respiration continues at an elevated level. Prolonged time in the plateau phase without progression to the orgasmic phase may result in sexual frustration.


Plateau in males

During this phase, the male urethral sphincter contracts (so as to prevent
urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excreted from the body through the urethra. Cellul ...
from mixing with
semen Semen, also known as seminal fluid, is an organic bodily fluid created to contain spermatozoa. It is secreted by the gonads (sexual glands) and other sexual organs of male or hermaphroditic animals and can fertilize the female ovum. Sem ...
, and to guard against retrograde ejaculation) and muscles at the base of the penis begin a steady rhythmic contraction. Males may start to secrete seminal fluid or pre-ejaculatory fluid and the
testicles A testicle or testis (plural testes) is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testosteron ...
rise closer to the body.


Plateau in females

The plateau stage in females is basically a continuation of the same changes evident in the excitement stage. The
clitoris The clitoris ( or ) is a female sex organ present in mammals, ostriches and a limited number of other animals. In humans, the visible portion – the glans – is at the front junction of the labia minora (inner lips), above the op ...
becomes extremely sensitive and withdraws slightly, and the Bartholin glands produce further
lubrication Lubrication is the process or technique of using a lubricant to reduce friction and wear and tear in a contact between two surfaces. The study of lubrication is a discipline in the field of tribology. Lubrication mechanisms such as fluid-lubric ...
. The tissues of the outer third of the vagina swell, and the
pubococcygeus muscle The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of t ...
tightens, reducing the diameter of the opening of the vagina. Masters and Johnson refer to the changes that take place during the plateau stage as the orgasmic platform. For those who never achieve orgasm, this is the peak of sexual excitement.


Orgasm phase

Orgasm is experienced by both males and females, ending the plateau phase of the sexual response cycle. Orgasm is accompanied by quick cycles of
muscle contraction Muscle contraction is the activation of tension-generating sites within muscle cells. In physiology, muscle contraction does not necessarily mean muscle shortening because muscle tension can be produced without changes in muscle length, such a ...
in the lower pelvic muscles, which surround both the anus and the primary sexual organs. Orgasms are often associated with other ''involuntary'' actions, including vocalizations and muscular spasms in other areas of the body and a generally euphoric sensation. Heart rate is increased even further.
Tantric sex Tantric sex or sexual yoga refers to a wide range of practices carried on in Hindu and Buddhist tantra to exercise sexuality in a ritualized or yogic context, often associated with antinomian or impure elements, like consumption of alcohol, and ...
practices may seek to diminish the goal of achieving orgasm, which is frequently a common goal of sexual intercourse.


Orgasm in males

In males, orgasm is usually associated with
ejaculation Ejaculation is the discharge of semen (the ''ejaculate''; normally containing sperm) from the male reproductory tract as a result of an orgasm. It is the final stage and natural objective of male sexual stimulation, and an essential compo ...
. Each ejection is accompanied with continuous pulses of sexual pleasure, especially in the penis and
loin The loins, or lumbus, are the sides between the lower ribs and pelvis, and the lower part of the back. The term is used to describe the anatomy of humans and quadrupeds, such as horses, pigs, or cattle. The anatomical reference also applies to pa ...
s. Other sensations may be felt strongly among the lower spine or lower back. The first and second convulsions are usually the most intense in sensation and produce the greatest quantity of semen. Thereafter, each contraction is associated with a diminishing volume of semen and a milder sensation of pleasure.


Orgasm in females

Women also experience
uterine The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
and
vaginal In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen. ...
contractions. Orgasms in females can vary widely from individual to individual. They are commonly associated with an increase in
vaginal lubrication Vaginal lubrication is a naturally produced fluid that lubricates a vagina. Vaginal lubrication is always present, but production increases significantly near ovulation and during sexual arousal in anticipation of sexual intercourse. Vaginal ...
, a tightening of the vaginal walls and overall pleasure. For some women, there is also a possibility of
female ejaculation Female ejaculation is characterized as an expulsion of fluid from the Skene's gland at the lower end of the urethra during or before an orgasm. It is also known colloquially as squirting (or gushing), although research indicates that female eja ...
(also called "squirting").


Resolution phase

The resolution phase occurs after orgasm and allows the muscles to relax, blood pressure to drop and the body to slow down from its excited state. The refractory period, which is part of the resolution phase, is the time frame in which usually a man is unable to orgasm again, though women can also experience a refractory period.


Resolution in males

Masters and Johnson described the two-stage detumescence of the penis: In the first stage, the penis decreases from its erect state to about 50 percent larger than its flaccid state. This occurs during the refractory period. In the second stage (and after the refractory period is finished), the penis decreases in size and returns to being flaccid. It is generally impossible for men to achieve orgasm during the refractory period. Masters and Johnson argue that this period must end before men can become aroused again. Although, due to the refractory period, it is rare for men to achieve ''
multiple orgasms Orgasm (from Greek , ; "excitement, swelling") or sexual climax is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic, involuntary muscular contractions in the pelvic region charact ...
'',Se
133–135
for orgasm information, an
page 76
for G-spot and vaginal nerve ending information.
some men have reported having multiple, consecutive orgasms, particularly without ejaculation. Multiple orgasms are more commonly reported in very young men than in older men. In younger men, the refractory period may only last a few minutes, but last more than an hour in older men.


Resolution in females

According to Masters and Johnson, women have the ability to orgasm again very quickly, as long as they have effective stimulation. As a result, they are able to have ''multiple orgasms'' in a relatively short period of time. Though generally reported that women do not experience a refractory period and thus can experience an additional orgasm, or multiple orgasms, soon after the first, some sources state that men and women experience a refractory period because women may also experience a period after orgasm in which further sexual stimulation does not produce excitement. For some women, the clitoris is very sensitive after climax, making additional stimulation initially painful. After the initial orgasm, subsequent orgasms for women may also be stronger or more pleasurable as the stimulation accumulates.


Similarities and differences between sexes

Masters and Johnson argue that, despite some minor differences, sexual responses in both men and women are fundamentally similar. However, researchers have argued that there are many differences between men and women in terms of their response. First, Masters and Johnson put forth one model for men, but three different models for women. They stated that men's sexual response only differs in terms of duration; showing different models would, thus, be repetitive. Women, on the other hand, they state can have responses that differ in both intensity and duration. These variations can pose problems because psychologists have argued that not everyone fits this model; for example, most women do not orgasm during penetrative sexual intercourse.Basson, R. (2000). "The female sexual response: A different model". '' Journal of Sex and Marital Therapy'' 26, 51–65. Masters and Johnson also equate a man's erection with a woman's vaginal lubrication during the excitement phase; Roy Levin states that this observation is false. A woman's clitoris is the anatomical parallel to a man's penis. As a result, clitoral swelling would be the equivalent of a man's erection. Another aspect is the lack of concordance between subjective
sexual arousal Sexual arousal (also known as sexual excitement) describes the physiological and psychological responses in preparation for sexual intercourse or when exposed to sexual stimuli. A number of physiological responses occur in the body and mind a ...
and genital arousal. Research by Meredith L. Chivers and J. Michael Bailey indicates that men tend to show category-specific arousal; that is, they are sexually aroused by their preferred gender. However, women show category non-specificity: Their genitals show arousal to both preferred and non-preferred genders. Even though women reported being subjectively aroused to, for example, a man and woman engaging in sexual activity, their genitals also show sexual arousal to two men engaging in sexual activity, two women doing so, and even non-human animals having sex. Overall, Masters and Johnson's model appears to be a better example of men's sexual response than women's.


Criticisms

There has been much research conducted based on Masters and Johnson's model. However, inaccuracies have been found in the descriptions of the stages of sexual response. For example, Roy Levin identified a few areas of the model that had not been touched upon. First, Masters and Johnson state that only the vagina is lubricated during the arousal stage; Levin argues that the labia produce their own lubricant. Levin also presents research which shows that the first signs of physiological arousal in women is increased blood flow to the vagina, not lubrication. He also dispels information about men and their sexual response; Masters and Johnson report that pleasure was positively associated with the volume of ejaculate released, but Rosenberg, Hazzard, Tallman and Ohl gave a group of men a questionnaire and found that significantly more men reported that physical pleasure was associated with the strength of the ejaculation compared to the volume. Moreover, some researchers have found that some men can have multiple orgasms, despite what Masters and Johnson had reported. Some researchers have also criticized how Masters and Johnson define sexual response solely in terms of physiology; for example, Everaerd, and Laan have found that sexual arousal can be defined as an emotional state in both men and women. Other researchers have stated that there is a lack of concordance between women's subjective sexual arousal and their genital arousal. Rosemary Basson argues that this model poorly explains women's sexual response, especially for those who are in long-term relationships.Basson, R. (2001). "Using a different model for female sexual response to address women’s problematic low sexual desire". ''
Journal of Sex & Marital Therapy The ''Journal of Sex & Marital Therapy'' is a peer-reviewed scientific journal published by Routledge and formerly by Brunner/Mazel. Its editor-in-chief is R. Taylor Segraves. Scope The ''Journal of Sex & Marital Therapy'' covers: * Sexual ...
'', 27, 395-403.


Other models

Shortly after Masters and Johnson published their book, several scholars criticized their model of the human sexual response cycle. For example, Helen Singer Kaplan argued that Masters and Johnson only evaluated sexual response from a physiological perspective, and that psychological, emotional, and cognitive factors need to be taken into consideration. As a result, she proposed her model of the sexual response cycle which includes three phases: desire, excitement, and orgasm. She argues that these three phases are interconnected, yet they have different neurophysiological mechanisms. Similarly, Paul Robinson argued that the excitement and plateau phases are the same; he criticizes Masters and Johnson's work for not clearly distinguishing when the excitement phase ends, and when the plateau phase begins. Another model that has been put forth is the incentive-motivation model. The model explains that the desire for sex comes from an interaction between a sensitive sexual response system and stimuli that are present in the environment. Researchers argue that this model supports the idea that sexual desire is not spontaneous. Furthermore, this model implies that the case is not that one has sex because one feels sexual desire; rather, the case is that one feels sexual desire because one has sex. Rosemary Basson proposed an alternative model of sexual response. She argues that the linear model is good at explaining men's sexual response but it poorly explains women's sexual responses; thus, she puts forth a ''circular model''. She states that closeness or attachment to a partner increases the effectiveness of sexual stimulation. This leads to enhanced sexual arousal, which may ultimately result in orgasm. Consequently, this positive sexual arousal continues the sexual desire that women feel, and this desire increases intimacy with the partner. Other researchers have attempted to evaluate women's sexual functioning in terms of this new model but have found contradictory results. In one study conducted by Giles and McCabe, they found that the linear model of sexual response was a good predictor of women's sexual functioning (and dysfunction), while the circular model was a poor predictor.Giles, K. R. & McCabe, M. P. (2009). "Conceptualizing women's sexual function: Linear vs. circular models of sexual response". '' The Journal of Sexual Medicine'' 6, 2761-2771. Once they modified the pathways of the model, the circular model then became a good predictor of sexual functioning. In another study looking at Malaysian women, researchers found that the circular model was actually a good predictor of women's sexual desire and arousal. More research needs to be done in this area to show whether the circular model more accurately describes women's sexual response.


Sexual dysfunctions

The human sexual response cycle set the foundation for studying and categorizing sexual dysfunctions in men and women. There are four main categories of sexual dysfunctions: desire disorders, arousal disorders, orgasm disorders, and sexual pain disorders. They are still categorized as such in the ''
DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
''. Recent research, however, suggests that the current model of sexual response needs to be revised to better treat these dysfunctions. One reason is that there is considerable overlap between sexual dysfunctions in women. One study found that in patients with hypoactive sexual desire disorder (HSDD), 41% of women had at least one other sexual dysfunction and 18% had diagnoses in all three categories (that is, in desire, arousal, and orgasm disorders). Another issue is that, among women, there is a discrepancy between desire and arousal. After Cynthia Graham critically evaluated female sexual arousal disorder (FSAD), she found that women reported that, contrary to Masters and Johnson's model, sexual arousal sometimes preceded sexual desire; at other times, desire presented before arousal. Because of the high comorbidity rates between HSDD and FSAD, she would like to merge them to make the category "Sexual Interest/Arousal Disorder." Hartmann and colleagues summarize their views of the current model of the sexual response cycle and conclude that "by simply expanding and continuing DSM-IV criteria and the traditional response cycle classification systems, it is impossible to come to diagnostic categories and subtypes that adequately reflect real-life female sexual problems".Hartmann, U., Heiser, K., Ruffer-Hesse, C., & Kloth, G. (2002). "Female sexual desire disorders: Subtypes, classification, personality factors and new directions for treatment". ''World Journal of Urology'', 20, 79-88.


See also

*
Erogenous zone An erogenous zone (from Greek , ''érōs'' "love"; and English ''-genous'' "producing", from Greek , ''-genḗs'' "born") is an area of the human body that has heightened sensitivity, the stimulation of which may generate a sexual response, suc ...
* Foreplay *
Oral sex Oral sex, sometimes referred to as oral intercourse, is sexual activity involving the stimulation of the genitalia of a person by another person using the mouth (including the lips, tongue, or teeth) and the throat. Cunnilingus is oral sex p ...
*
Orgastic potency Within the work of the Austrian psychoanalyst Wilhelm Reich (1897–1957), orgastic potency is a human's natural ability to experience an orgasm with certain psychosomatic characteristics . "Reich's model takes a unisex, 'integrated biopsychol ...
*
Sexual attraction Sexual attraction is attraction on the basis of sexual desire or the quality of arousing such interest. Sexual attractiveness or sex appeal is an individual's ability to attract other people sexually, and is a factor in sexual selection or ...


References

{{Reflist


External links


Human sexual response on Discovery health

Human Sexual Response Cycles by Dr. Mitchell Tepper on SexualHealth.com

What We Can Learn from Sexual Response Cycles
''
Psychology Today ''Psychology Today'' is an American media organization with a focus on psychology and human behavior. It began as a bimonthly magazine, which first appeared in 1967. The ''Psychology Today'' website features therapy and health professionals direc ...
''
Blog on the Sexual Response Cycle

Classifying Sexual Dysfunctions and Recommendations for the DSM-V

Female Sexual Arousal Disorder and Its Current Issues

In-Depth Presentation on Masters and Johnson and their Contribution to Sex Research
DistinctiveVoicesBC,
YouTube YouTube is a global online video sharing and social media platform headquartered in San Bruno, California. It was launched on February 14, 2005, by Steve Chen, Chad Hurley, and Jawed Karim. It is owned by Google, and is the second mo ...
Sexual arousal Fertility