Female Sexual Dysfunction
What is sexual dysfunction?
Sexual dysfunction refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm and resolution.
What causes sexual dysfunction?
Causes of sexual dysfunction include:
Physical causes
Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart disease, neurological disorders, hormonal imbalances, menopause, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressants drugs, can affect sexual desire and function.
Psychological causes
These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.
How does sexual dysfunction affect women?
The most common problems related to sexual dysfunction in women include:
Inhibited sexual desire
This involves a lack of sexual desire or interest in sex. Many factors can contribute to a lack of desire, including hormonal changes, medical conditions and treatments (for example cancer and chemotherapy), depression, pregnancy, stress and fatigue. Boredom with regular sexual routines also may contribute to a lack of enthusiasm for sex, as can lifestyle factors, such as careers and the care of children.
Inability to become aroused
For women, the inability to become physically aroused during sexual activity often involves insufficient vaginal lubrication. The inability to become aroused also may be related to anxiety or inadequate stimulation. In addition, researchers are investigating how blood flow disorders affecting the vagina and clitoris may contribute to arousal problems.
Lack of orgasm (anorgasmia)
Delay or absence of sexual climax (orgasm). It can be caused by sexual inhibition, inexperience, lack of knowledge and psychological factors such as guilt, anxiety, or a past sexual trauma or abuse. Other factors contributing to anorgasmia include insufficient stimulation, certain medications and chronic diseases.
Painful intercourse
Pain during intercourse (dyspareunia) can be caused by a number of problems, including endometriosis, pelvic mass, ovarian cysts, inflammation of the vagina (vaginitis), poor lubrication, the presence of scar tissue from surgery and a sexually transmitted disease. A condition called vaginismus is a painful, involuntary spasm of the muscles that surround the vaginal entrance. It may occur in women who fear that penetration will be painful and also may stem from a sexual phobia or from a previous traumatic or painful experience.
How is female sexual dysfunction diagnosed?
The doctor likely will begin with a thorough history of the problem and any associated symptoms followed by a physical exam. The doctor may perform a pelvic examination to evaluate the health of the reproductive organs and a Pap test to detect changes in the cells of the cervix (to check for cancer or a pre-cancerous condition). He or she may order other diagnostic tests to rule out any medical problems that may be contributing to the dysfunction.
An evaluation of the person’s attitudes regarding sex, as well as other possible contributing factors (fear, anxiety, past sexual trauma/abuse, relationship problems, alcohol or drug abuse, etc.) will help the doctor understand the underlying cause of the problem and make appropriate recommendations for treatment.
How is female sexual dysfunction treated?
The ideal approach to treating female sexual dysfunction involves a team effort between the patient, health care providers and trained therapists. Most types of sexual dysfunction can be corrected by treating the underlying physical or psychological problems. Other treatment strategies focus on the following:
Providing education
Education about human anatomy, sexual function and the normal changes associated with aging, as well as sexual behaviors and responses, may help a woman overcome her anxieties about sexual function and performance.
Enhancing stimulation
This may include the use of erotic materials (videos or books), masturbation and changes to sexual routines.
Providing distraction techniques
Erotic or non-erotic fantasies; exercises with intercourse; music, videos or television can be used to increase relaxation and eliminate anxiety.
Encouraging non-coital behaviors
Non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage, can be used to promote comfort and increase communication between partners.
Minimizing pain
Using sexual positions that allow the woman to control the depth of penetration may help relieve some pain. The use of vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation.
How do hormones affect sexual function?
Hormones play an important role in regulating sexual function in women. With the decrease in the hormone estrogen that is related to aging and menopause, many women experience some changes in sexual function as they age. Decreased vaginal lubrication and altered genital sensation are problems associated with changes in estrogen levels. Further, research suggests that low levels of the hormone testosterone also contribute to a decline in sexual arousal, genital sensation and orgasm. Researchers still are investigating the benefits of hormones and other medications, including sildenafil (Viagra), to treat sexual dysfunction in women.
What effect does a hysterectomy have on sexual function?
Many women experience changes in sexual function after a hysterectomy. For some women, sexual function improves. For others, there may be a loss of desire, and decreased lubrication and sensation with intercourse. These problems may be associated with the absence of the uterus and the hormonal changes that occur if the ovaries are removed. Further, nerves and blood vessels critical to sexual function can be damaged during the hysterectomy procedure.
How does menopause affect a woman’s sexual function?
The loss of estrogen following menopause can lead to changes in a woman’s sexual functioning. Emotional changes that sometimes accompany menopause can add to a woman’s loss of interest in sex and/or ability to become aroused. Hormone replacement therapy may improve certain conditions, such as loss of vaginal lubrication and genital sensation that can create problems with sexual function.
It should be noted that some post-menopausal women report an increase in sexual satisfaction. This may be due to decreased anxiety associated with a fear of pregnancy. In addition, post-menopausal woman often have fewer child-rearing responsibilities, allowing them to relax and enjoy spontaneous intimacy with their partners.
When should I call my health care provider?
Many women experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the woman and her partner, and have a negative impact on their relationship. If you consistently experience these problems—especially pain during intercourse—see your health care provider for evaluation and treatment.