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    Sexual Dysfunction Clinic

    Female

    Female Sexual Dysfunction:

    A sexual problem, or 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. Research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty).

    There are a number of risk factors that may contribute to Sexual dysfunction in women. A risk factor is not necessarily the cause of a problem, but rather something that makes the problem more likely.

    Physical causes: Many physical and/or medical conditions can cause problems with sexual function. A woman's sense of personal well being is important to sexual interest and activity. A woman who does not feel her best physically or emotionally may experience a decrease in sexual interest or response. The disorders most likely to result in sexual dysfunction are those that lead to problems in circulatory or neurological function. These conditions include diabetes, heart disease, neurological diseases, hormonal imbalances, menopause plus such chronic diseases as kidney disease or liver failure, and alcoholism or drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function. Women with cancer can experience discomfort and fatigue, due to both the disease and its treatments, which impacts sexual function. Changes in body image, especially after surgery on the breasts or other intimate areas, can contribute to sexual problems in women with cancer.

    Endocrine conditions: Hormones play an important role in regulating sexual function in women. With the decrease in the female hormone estrogen with age and menopause, many women experience some changes in sexual function as they age, including poor vaginal lubrication and decreased genital sensation. Many women experience changes in sexual function after surgical removal of the uterus. These changes may include a loss of desire, and decreased vaginal lubrication and genital sensation. These problems may be associated with the hormonal changes that occur with the loss of the uterus. Furthermore, nerves and blood vessels critical to sexual function can be damaged during the surgery.

    Menopause: The loss of estrogen following menopause can lead to changes in a woman's sexual functioning. Emotional changes that often accompany menopause can add to a woman's loss of interest in sex and/or ability to become aroused. Hormone replacement therapy (HRT) or vaginal lubricants may improve certain conditions, such as loss of vaginal lubrication and genital sensation, which can create problems with sexual function in women. Some postmenopausal women shows increase in sexual satisfaction. This may be due to decreased anxiety over getting pregnant and have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.

    Childbirth: You may have less sexual desire during pregnancy, right after childbirth or when you are breastfeeding. After childbirth, physical recovery and breastfeeding, as well as fatigue and the demands of parenting, often decrease sexual desire. Low estrogen levels after delivery and local injury to the genital area at delivery may result in pain during intercourse. In most cases, these issues improve with time.

    Polycystic ovary syndrome: Polycystic ovarian syndrome (PCOS) is a condition in which the ovaries produce high amounts of androgens or male hormones, especially testosterone which results in ovulation problems.

    Symptoms of polycystic ovary syndrome:

    The signs and symptoms vary from person to person, in both type and severity. Frequently, PCOS symptoms are mistaken for other medical illnesses. Menstrual abnormality is the most widespread characteristic of PCOS. Increased androgen levels are a key feature of PCOS, and may result in excess facial and body hair (hirsutism), adult acne and male-pattern baldness (in women). A woman that finds herself with irregular menstrual cycles, excess facial and body hair, adult acne, weight gain, infertility and enlarged ovaries may have polycystic ovary syndrome (PCOS). PCOS is the most common cause of female infertility. Many women with polycystic ovary syndrome experience infrequent ovulation or lack of ovulation altogether and may have trouble becoming pregnant, PCOS also is associated with spontaneous abortion and preeclampsia.

    Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, or the effects of a past sexual trauma. Psychologically, possible causes of the disorder include the impact of childhood and adolescence experiences and current events both within the individual and within the relationship. The impact of childhood experiences on female sexual dysfunction is methodologically unproven but there have been some observation on childhood sexual abuse and having a later sexual dysfunction. Human sexual behavior also varies with hormonal state, social context, and cultural conventions. Ovarian hormones influence female sexual desire, but the specific sexual behaviors engaged in are affected by perceived pregnancy risk, reiterating that cognition plays an important role in human sexual behavior.

    Women are most likely to be satisfied with their sex lives if they are physically and psychologically healthy and have a good relationship with their partner. Although a host of changes in hormones, blood vessels, the brain, and vaginal area can affect a woman's sexuality, relationship difficulties and poor physical or psychological well-being are the most common causes of sexual problems.

    Female sexual dysfunction can be subdivided into desire, arousal, orgasmic and sexual pain disorders. Both men and women can have it. There are 4 kinds of sexual problems in women:

    Inhibited sexual desire (Desire disorders): 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 (Arousal disorders): Female sexual arousal disorder, commonly referred to as frigidity, is a disorder characterized by a persistent or recurrent inability to attain sexual arousal or to maintain arousal until the completion of a sexual activity. This involves insufficient vaginal lubrication. This inability also may be related to anxiety or inadequate stimulation. In addition, researchers are investigating how blood flow problems affecting the vagina and clitoris may contribute to arousal problems.

    Lack of orgasm (Orgasmic disorders): This is the absence of sexual climax (orgasm). It can be caused by a woman's 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 (Sexual pain disorders): Pain during intercourse can be caused by a number of problems, including endometriosis, a pelvic mass, ovarian cysts, vaginitis, poor lubrication, the presence of scar tissue from surgery, or 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.

    Diagnosis:

    An evaluation of person’s attitudes regarding sex, other contributing factors such as fear, anxiety, past sexual trauma/abuse, relationship problems, or alcohol or drug abuse will help the doctor understand the underlying cause of the problem and make appropriate treatment recommendations.

    To diagnose female sexual dysfunction, the doctor likely will begin with a physical exam and a thorough evaluation of symptoms. The doctor may perform a pelvic exam to evaluate the health of the reproductive organs and a Pap smear to detect changes in the cells of the cervix.

    It also involves examining the inadequate lubrication-swelling response present during arousal and sexual activity. The condition should be distinguished from a general loss of interest in sexual activity and from other sexual dysfunctions, such as the orgasmic disorder and hypoactive sexual desire disorder, which is characterized as a lack or absence of sexual fantasies and desire for sexual activity for some period of time. The doctor may order other tests to rule out any medical problems that may be contributing to the woman's sexual dysfunction.

    Female dysfunction treatment:

    The ideal approach to treating female sexual dysfunction involves a team effort between the woman, doctors, and trained therapists. Most types of sexual problems can be corrected by treating the underlying physical or psychological problems.

    Problems related to menopause: A woman may experience vaginal dryness and other changes when estrogen drops after menopause that may make sex painful. An estrogen therapy can resolve this issue. Over-the-counter products are available as creams or gels for women who experience vaginal dryness. The hormone produced by the body’s adrenal glands dehydroepiandrosterone gets lower as women grow older. Some studies show DHEA may help restore libido in older women, with no effect on younger women. None of the treatment strategies are to be used without a doctor prescription.

    Manage stress and relationship issues: Stress, fatigue, lack of privacy, personal values, and religious beliefs can all impact sexuality. Conflict in a relationship and difficulties with communication also are a significant cause of decreased sexual desire and response for women. Working with a professional counselor or sex therapist can help individuals and couples reduce stress and strengthen their relationships. Education about human anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and appropriate responses, may help a woman overcome her anxieties about sexual function and performance.

    Enhancing stimulation: This may include the use of erotic materials, masturbation, and changes in 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 include physical stimulation 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. Vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation. Many women who have pain with sex have tight and tender muscles and connective tissue in the pelvis, lower belly, thighs, groin, and buttocks. Pelvic floor physical therapy (PT) can help to decrease tightness in these muscles. Painful sex due to involuntary tightening of the muscles of the vaginal wall, called vaginismus can be best treated by the use of vaginal dilators and gently stretching the vagina over several months.

    DHEA replacement: Use of DHEA can improve sexual interest and satisfaction in some women whose adrenal glands no longer function. However, DHEA is not proven to be safe or effective for other women, and it is not generally recommended. In addition, DHEA is produced as a nutritional supplement, and the amount of hormone may vary from one pill or bottle to another.

    Herbal therapies: Many women are interested in trying over-the-counter herbal supplements, which are advertised to increase sexual desire and pleasure. Some herbal supplements may improve sexual function, but no more than would a placebo.

    Surgical treatments: Surgery is very rarely necessary to make the vagina better for sex. Women with abnormalities of the vagina, who have had female genital mutilation and those with traumatic injuries from childbirth, are a few groups that may benefit from careful surgical treatment.

    Polycystic ovary syndrome treatment: Treatment depends on the severity of the condition. Recent studies have shown insulin to be a factor in many women with PCOS. In mild cases, the healthcare provider may suggest a reduced fat and carbohydrate diet, along with aerobic exercise. Severe PCOS can be treated by drug therapies. Ovulation induction drugs can help the ovaries to release eggs. Insulin-regulating drugs such as metformin may correct ovulatory problems. Some severe cases require surgery. The outer layer of the ovary can become thickened and may interfere with ovulation. Laser ovarian drilling is a surgical method that yields the same results as a wedge resection. Laparoscopic ovarian drilling may help thin the outer layer in places.
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