Female Sexual Dysfunction

Female Sexual Dysfunction is a chronic disturbance in the sexual response cycle.

Causes

The sexual response cycle consists of three stages: desire, arousal, and orgasm. It relies on mental stimulation, nerve signals, hormones, and blood flow. Sexual dysfunction can arise if any of these processes are disturbed.
Sexual dysfunctions include:
Hypoactive sexual desire disorder - low sexual desire. Causes include conditions or medications that interfere with nerve signals, such as:

  • Hormone deficiencies
  • Neuropsychiatric disorders
Sexual aversion disorder - strong desire to avoid sexual activity. Caused primarily by psychological factors stemming from traumatic experiences, such as:
  • Childhood sexual abuse
  • Painful sexual experiences
  • Feelings of shame and guilt
Female sexual arousal disorder - inability to attain or maintain a physical response to sexual arousal. Physical causes include conditions and medications that interfere with nerve signals or blood flow, such as:
  • Diabetes
  • Arteriosclerosis
  • High blood pressure medications
Female orgasmic disorder - inability to achieve orgasm or delayed orgasm. Physical causes include:
  • Surgery
  • Hormone deficiencies
  • Certain medications, including antidepressants
Dyspareunia - pain during sexual intercourse. Physical causes include:
  • Insufficient vaginal lubrication
  • Inflammation of the bladder (cystitis)
  • Endometriosis
Vaginismus - painful spasms of the muscles of the vagina preventing intercourse. Physical causes include:
  • Vaginal infection
  • Endometriosis
Psychological causes:
  • Sexual guilt.
  • Grief
  • Trauma
  • Depression
  • Interpersonal conflict with a sexual partner

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
Medical conditions and diseases:
  • Arteriosclerosis
  • Autoimmune disorders
  • Cancer
  • Diabetes
  • High blood pressure
  • Endocrine disorders
  • Nerve disorders (i.e., multiple sclerosis, peripheral neuropathy, stroke)
  • Sexually transmitted diseases
  • Skin disorders (i.e., eczema, contact dermatitis)
  • Spinal cord injury
  • Urinary tract infections
Gynecologic disorders, procedures, and changes:
  • Bladder or uterine prolapse
  • Hysterectomy
  • Oophorectomy (removal of one or both of the ovaries)
  • Mastectomy
  • Endometriosis
  • Uterine fibroids
  • Vaginitis
  • Complications of gynecologic surgery
  • Pregnancy and post-partum period
  • Lactation
  • Menopause
Medications:
  • Antidepressants
  • Antipsychotics
  • Antiepileptics
  • Antihistamines
  • Antihypertensives and other cardiac medications
  • Anabolic steroids
  • Antianxiolytics
  • Narcotics
  • Alcohol
  • Oral contraceptives
  • Smoking
  • Cancer chemotherapy
Psychological and social conditions:
  • Life stressors
  • Anxiety or depression
  • Grief
  • Guilt
  • Rape
  • Interpersonal conflict with a sexual partner
  • Sexual identity conflicts

Symptoms

Symptoms of sexual dysfunction include:
  • Loss of desire
  • Lack of lubrication
  • Lack of clitoral/vaginal sensation
  • Delayed orgasm
  • Pain during intercourse
  • Involuntary vaginal contraction that inhibits penetration

Diagnosis

Your doctor will ask about your symptoms, medical history and the medications you take. Your doctor will also conduct a gynecologic exam.

Tests may include:
  • Urine tests
  • Blood tests
If psychological issues are involved, the doctor may refer you to a:
  • Psychiatrist
  • Psychologist
  • Sex therapist

Treatment

Treatment depends on whether the cause of the sexual dysfunction is correctable. If not, the doctor may recommend behavioral techniques to enhance sexual desire and decrease discomfort.
Treatments may include:
Eros - a \"clitoris pump\" that uses a suction cup and hand-held vacuum device to increase blood flow to the clitoris
Estrogen Replacement Therapy (ERT) - to increase libido, improve clitoral sensation, and decrease pain during intercourse for women in menopause. For women with other estrogen-depleting conditions, topical estrogen cream and Estring can also help with vaginal irritation, pain, or dryness.
Testosterone - used most effectively in menopausal women to increase libido and clitoral sensitivity
Lubricants - vaginal lubricants to relieve dyspareunia, vaginal dryness, and irritation. These are available over the counter.
Vaginal Dilators - inserted into the vagina for 15 minutes, twice daily, to treat vaginismus
Pelvic Exercises - Kegel exercises and techniques to relax the vaginal muscles and relieve orgasmic disorders and vaginismus

Prevention

You cant avoid all the risk factors for female sexual dysfunction. However, the steps below will help you avoid certain risk factors.
  • If a medical condition is the cause, follow the treatment.
  • If medications are the problem, ask your doctor about changing the medication or the regimen.
  • Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
  • Avoid emotional stress.
  • If interpersonal conflict is the cause, try relationship counseling.