Dr. Goldstein, San Diego Sexual Medicine At Alvarado Hospital explains what sex steroids are and how the vagina reacts when women have low levels of testosterone.
The vagina is an organ that is very sensitive to the hormonal milieu. It is an organ that has a epithelial surface that is very sensitive to estrogen. It has underneath the epithelium a series of blood vessels that are again very sensitive to estrogen, but surrounding into the third layer so after the blood vessel there called the lamina propria is the muscularis of the vagina, and that is the muscle that either relaxes or squeezes.
So it’s squeezed in the baseline state and relaxed in the sexual state, has very important androgen area, there are androgen receptors in the muscle, just like there is androgen receptors in all muscles and that aspect of the vagina does do well in the presence of testosterone and does less well in the lack of testosterone. So that muscle would be determining the girth and width of a sexually aroused vagina.
Dr. Irwin Goldstein: So then the whole point is we look at the vagina, we look at the anatomy of a woman and we say, "Oh, woman, estrogen", and what we’re saying here is that, "Oh, woman, estrogen and testosterone." Woman equals Homosapien, Homosapien requires all sex steroids, and sex steroids is estrogen and testosterone.
Now, in addition the vagina which is four-fifths müllerian in its embryology so it comes from the specific embryology that it relates to the uterus. There’s the uterovaginal canal; one-fifth of the vagina from the hymen to the labia is actually the same as the urethra.
When you look at a vestibule, the outside part of the vagina, and you can see a clitoris and you can see the two frenula coming off the glands in the two labia. If you took super glue and actually super glued all that together, that would look like a male.
If you actually take a male and stretch the penis up there’s a line that goes from the urethra all the way down to the anus. So it’s, if you would unravel that, that would be the woman, and if you put that together, that’s the guy. The region in the midline is the urethra, that’s what the man urinates through, and the woman from the hymen to the labia is urethra embryologically and that’s testosterone.
So testosterone is very important for the integrity of sensation. There are glands that release mucus and that help lubricate the area during sexual arousal. Failure to have testosterone is part of the condition of vulvodynia or vulvar vestibulitis syndrome.
So the bottom line is to keep a woman healthy and happy in aging, attention to sex steroids, not just estrogen is important.
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