PDE5i and vaginal orgasm: Reply to letter from S Brody

The points made by Stuart Brody in his letter relating to our paper on the use of phosphodiesterase type 5 inhibitors (PDE5i) are well taken.

It may well be that the ability to orgasm vaginally is related to the degree of accessibility of the clitoral body that is exposed to penile thrusting in the anterior vaginal wall, ¹ and that the size of the clitoral body correlates with the ability to orgasm vaginally. ¹ Furthermore, PDE5i have a direct effect on clitoral blood flow. ²

However, there is a body of recent research that continues to show poor correlations between genital arousal (most commonly measured by vaginal blood flow) and subjective sexual arousal. ^3–5 This may in part be related to the fact that genital arousal in women responds to much broader categories of visual stimuli compared with men. ⁵ Other authors have attributed poor correlations between subjective and genital arousal to inadequate methodology and statistical analysis. ⁶