Human sexual response is depicted as a motivation/incentive-based cycle of overlapping phases of variable order. A sense of desire may or may not be present initially: it can be triggered alongside the sexual arousal resulting from attending to sexual stimuli. Sexual arousal comprises subjective (pleasure/excitement/wanting more of the same) and physical (genital and non-genital responses). Psychologic and biologic factors influence the brain's appraisal of the sexual stimuli. The sexual and non-sexual outcomes influence present and future sexual motivation. ANS, autonomic nervous system.
The sexual response cycle may be weakened at all stages by neurologic disease. Incentives lessen as intimacy between partners is altered and expectation of reward fades. Reduced sensation and mobility limit the effectiveness of stimulation. Attention to stimuli is interrupted by distractions about illness or sexual outcome or by difficulties in concentration. Appraisal of stimuli is negatively affected by depression, medication, or pain, thereby precluding subjective arousal. A sense of desire may not be triggered. Autonomic involvement limits physical arousal and orgasm. The outcome is unsatisfactory and lessens any future motivation. ANS, autonomic nervous system.
Brain areas activated during sexual arousal to allow: (1) continued focus on sexual stimuli, imaging of sexual behavior, evaluation/censorship, and limitation or prevention of actual behavior despite arousal (all constituting a cognitive component of arousal); (2) sexual feelings (an emotional component); (3) anticipation of reward (a motivational component); and (4) an autonomic/ neuroendocrine response of physical sexual arousal.