Female Sexual Dysfunction
What is female sexual dysfunction?
Female sexual dysfunction (FSD) refers to physical or psychological problems that interfere with a woman’s ability to enjoy sex. Normal sexual function is a complex interplay between the mind and body. The physical aspects include actions by the nervous, circulatory and endocrine systems. The psychological factors include thoughts, emotions, experiences, attitudes and beliefs. A disruption in any of the physical or psychological components of sexual function can lead to FSD.
Normal sexual function involves four phases:
- Motivation, which is the desire to engage in sex
- Arousal, which has a physical component—blood flow increases to the genitals bringing about swelling and lubrication—and a subjective component—feelings or thoughts that indicate excitement
- Orgasm, which is the peak or climax of excitement with muscular tension and contraction
- Resolution, which is muscular relaxation and an overall sense of well-being after orgasm
Female sexual dysfunction causes problems with these phases of sexual function or with sexual intercourse itself.
There are four basic types of FSD:
- Sexual desire/interest disorder, which is low sexual desire or a lack of interest in engaging in sex
- Sexual arousal disorder, which is difficulty becoming aroused or maintaining arousal with or without changes in sexual desire
- Orgasmic disorder, which is absence of orgasm, difficulty achieving orgasm, or greatly diminished orgasm intensity despite adequate arousal
- Sexual pain disorder, which is painful intercourse or pain with vaginal contact or sexual stimulation
It’s important to note that some women have these issues, but aren’t bothered by them. In FSD, distress about sexual function is present and can lead to problems with a woman’s relationships.
It’s also important to understand that the different disorders can feed each other. For example, having trouble reaching orgasm can contribute to a lack of desire for sex. Experiencing pain with sex can make it hard to become aroused. Most women with FSD have aspects of more than one disorder. This overlap can make it hard to diagnose the specific problem. So, it’s often more useful to address a woman’s overall sexual function and satisfaction than to make distinctions about specific disorders.
Female sexual dysfunction is fairly common among American women. Research estimates about half of women experience some sort of FSD at some point during their lives. FSD is more common in women with mood disorders or a history of sexual abuse. Age increases the risk of FSD as well. Medications, medical conditions, and hormone level changes can also contribute to FSD.
Female sexual dysfunction treatment often involves several methods since the underlying cause is usually multifactorial. Treating any underlying physical condition may improve sexual function. Counseling is frequently part of a treatment plan, even if the primary cause is physical. Discussing the issue with a partner can help enhance intimacy and sexual response. There are also approved treatments to help stimulate desire and arousal.
Sexual dysfunction is only a problem if it bothers you; and if it does, you don’t have to live with it. FSD is also a difficult topic for many women. If your sexual function is interfering with your quality of life or relationships, see a doctor who makes you feel comfortable enough to discuss the problem.
What are the symptoms of female sexual dysfunction?
Female sexual dysfunction symptoms can vary depending on the phase of sexual function that is most affected. Commonly, women with FSD have symptoms that overlap between disorders. This happens because one disorder often contributes to another. It can be less useful to try to separate the disorders and more helpful to focus on what a woman perceives as the most problematic symptoms.
Sexual desire/interest disorder
Common symptoms of sexual desire/interest disorder include:
- Absence of responsive desire or the readiness to have sex with your partner
- Absent or decreased sexual thoughts and fantasies
- Absent or decreased desire or interest in having sex
Sexual arousal disorder
Common symptoms of sexual arousal disorder include:
- Absent or decreased engorgement—or swelling of the clitoris and vaginal walls
- Absent or decreased lubricating vaginal secretions
- Desire, or the feeling of sexual excitement may be intact or missing
Common symptoms of orgasmic disorder include:
- Absent orgasm
- Difficulty achieving orgasm
- Decreased intensity of orgasms
These symptoms are present despite having adequate arousal and ongoing stimulation.
Sexual pain disorder
Common symptoms of sexual pain disorder include:
- Pain with sexual arousal or stimulation
- Pain with vaginal contact or attempted or completed vaginal penetration
- Pain with intercourse
- Tightening of the vaginal muscles that doesn’t allow penetration or inability to relax them enough to allow penetration
If these symptoms are persistent or recurrent and are causing you distress, see your doctor. To reach a female sexual dysfunction diagnosis, your doctor will need to explore physical and psychological causes. This may involve a pelvic exam to look for physical or structural problems and possibly a blood test to look for underlying medical problems. You will need to be candid about the symptoms you are having, your sexual history, and your relationships. These can be difficult and vulnerable topics, so it’s important to work with a doctor you trust.
What causes female sexual dysfunction?
Like the symptoms of female sexual dysfunction, the causes of FSD are often interrelated. The causes fall into three broad categories:
Hormonal changes after giving birth, during breastfeeding, and after menopause can contribute to FSD. These changes can affect the desire for sex, as well as your physical response to stimulation. When hormone levels fall after menopause, the following effects can cause FSD:
- Decreased blood flow to the pelvis and genitals, which can interfere with genital sensation and arousal response
- Thinning of the vaginal walls and loss of elasticity, which can cause discomfort during intercourse
- Vaginal dryness and lack of lubrication, which can also cause discomfort during sex
Physical causes that can lead to FSD include:
- Medical conditions, such as cancer, diabetes, heart disease, kidney failure, thyroid disorders, and nerve and nervous system disorders
- Medications and drugs, including alcohol, antidepressants, antihistamines, blood pressure medicines, chemotherapy, and antiseizure drugs
- Vaginal problems, including infections, structural birth defects, and surgical scarring
Psychological causes of FSD can include:
- Cultural, religious or social beliefs, attitudes and norms
- Low self-image due to such issues as infertility, menopause, surgery, or other factors that contribute to a sense of loss of sexuality or femininity
- Mental health or emotional problems, such as stress, anxiety or guilt
- Previous experiences, such as abuse or negative sexual encounters
- Relationship issues, such as anger, conflicts, or lack of trust
What are the risk factors for female sexual dysfunction?
Any woman can experience sexual dysfunction at any stage of life. However, it tends to increase with age and is most common in women over 40 years of age. The hormonal changes and medical conditions that develop with age are a main contributor. Other factors that increase the risk of developing FSD include:
- Eating disorders
- History of emotional, physical, or sexual abuse, especially during childhood or adolescence
- Major life stressors, such as death of a loved one, divorce, major illness, or job loss
Reducing your risk of female sexual dysfunction
You may be able to lower your risk of female sexual dysfunction by developing a healthy attitude toward yourself and sex. This may include learning to accept and even appreciate your body and being comfortable with yourself as a sexual being.
Try these lifestyle habits to enhance your sexual health:
- Get regular physical exercise
- Limit alcohol consumption
- Make time for yourself to enjoy hobbies and other activities
- Practice relaxation techniques, such as meditation and mindfulness
- Stop smoking
- Treat medical conditions that can contribute to FSD
These habits minimize or eliminate things that can blunt your sexual response. They also maximize things that support a healthy sexual response, such as stamina, so-called “feel good” hormones, and the ability to control stress.
It isn’t always possible to anticipate the problems that can lead to FSD. Having an established relationship with a doctor you trust can help you address any potential problems in a timely manner. See your doctor sooner rather than later if issues with sex begin to trouble you. If necessary, your doctor can refer you to a sexual health specialist.
How is female sexual dysfunction treated?
Doctors recommend treatment of female sexual dysfunction if the problem bothers you or interferes with your relationships. Because the symptoms and causes of FSD are often interrelated, treatment usually relies on more than one approach including:
- Counseling with a therapist who specializes in relationships and sexual problems. Even if relationship issues aren’t the main contributor to FSD, counseling can still be useful. Learning to communicate more effectively with your partner can deepen intimacy and help your partner understand how to help you.
- Devices, including vaginal dilators to open tightened muscles, vibrators to aid stimulation, and a clitoral vacuum device (Eros) to increase blood flow and promote engorgement
- Estrogen replacement, which can be systemic in pill form or localized in the form of creams or a vaginal tablet or ring. This treats symptoms of low estrogen that commonly develop during menopause. It increases blood flow, lubrication, and vaginal tone and elasticity. However, it isn’t right for every woman.
- Medications, including ospemifene (Osphena) to reduce pain during sex and flibanserin (Addyi) to treat low sexual desire in premenopausal women. If medications are (or could be) contributing to FSD, your doctor may change your dose or switch to a different medication.
- Non-medical treatments, which may include lubricants and vaginal moisturizers
Your healthcare provider will tailor the treatment based on your individual needs. Be upfront and honest about the symptoms that bother you and your goals. You need to have the courage to talk about your body’s response and whether or not it improves with treatment. This will help your provider understand if treatment is working for you or not.
There are several drugs under investigation for the treatment of FSD. This includes phosphodiesterase inhibitors, such as sildenafil (Viagra), that are approved treatments for male erectile dysfunction. Researchers also continue to study testosterone therapy for female sexual dysfunction in women who have low levels of it. Both of these treatments show mixed results in studies to date.
What are the potential complications of female sexual dysfunction?
Female sexual dysfunction is a problem if the symptoms cause distress or interfere with your relationships. Occasional sexual problems are a normal part of life. However, if sexual problems persist or recur, not addressing them can cause more problems if it strains your enjoyment of life or your relationship with your partner. Open communication with your partner can solve many problems and improve sexual satisfaction for both of you.