Female sexual dysfunction is a chronic disturbance in the sexual response cycle.

Causes

The sexual response cycle consists of three main aspects: desire, arousal, and orgasm. The sexual response cycle is very complex and sensitive; it relies on mental stimulation, mood, 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 or low libido. Causes are mostly not understood; they include conditions or medications that interfere with nerve signals, such as:

• Hormone deficiencies

• Neuropsychiatric disorders

• Stress

• Absence of sense of love and security

• History of sexual or other abuse

• Antidepressant medication

Sexual Aversion Disorder – strong desire to avoid sexual activity. Caused primarily by psychological factors stemming from traumatic experiences, such as:

• Childhood sexual abuse

• Adult 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:

• Absence of an adequate desire phase of the cycle

• Diabetes

• Arteriosclerosis

• Age

• Medications, including many blood pressure and psychiatric drugs

Female Orgasmic Disorder – inability to achieve orgasm or delayed orgasm. Causes are not well understood. Some causes include:

• Inadequate desire phase of the cycle

• Inadequate arousal phase of the cycle

• History of sexual and other abuse

• Surgery

• Hormone deficiencies

• Certain medications, including antidepressants

Dyspareunia – pain during sexual intercourse. Physical causes include:

• Inadequate arousal

• Vulvodynia, vulvar vestibulitis

• Ovarian cyst

• Insufficient vaginal lubrication

• Inflammation of the bladder (cystitis)

• Endometriosis

• Vaginal or pelvic infections

Vaginismus – painful spasms of the muscles of the vagina preventing intercourse. Physical causes include:

• Prior experience of discomfort

• Vaginal scarring from previous injuries, surgeries, or childbirth

• Vaginal irritation or inflammation from douches, spermicides, or latex condoms

• Vaginal infection

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.

Risk factors include:

Medical conditions and diseases:

• Arteriosclerosis

• Autoimmune disorders

• Cancer

• Diabetes

• High blood pressure

• Endocrine disorders

• Nerve disorders (ie, multiple sclerosis, peripheral neuropathy, stroke)

• Sexually transmitted diseases

• Skin disorders (ie, 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 postpartum 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.

Diagnosis may include:

• Swabs of vaginal fluid to evaluate for infection or bacterial imbalance

• Cervical swabs to test for sexually transmitted diseases (STDs)

• Urine tests

• Blood tests

• Doing homework addressing condition (individual or couple)

• Arousal blood-flow testing

• Skin sensation testing

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 working with a sex therapist and/or:

Estrogen Replacement Therapy (ERT) – For women with other estrogen-depleting conditions, topical estrogen cream and Estring can also help with vaginal irritation, pain, or dryness. ERT may help with arousal disorder. There is an absence of evidence that estrogen supplementation will benefit sex drive/libido.

Lubricants – Vaginal lubricants are used to relieve dyspareunia, vaginal dryness, and irritation. These are available over-the-counter.

Vaginal Dilators – This treatment is inserted into the vagina for 15 minutes, twice daily, to treat vaginismus.

Pelvic Exercises – Kegel exercises and techniques are used to relax the vaginal muscles and relieve orgasmic disorders and vaginismus

Prevention

You can't 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.

RESOURCES:

American Academy of Family Physicians
http://www.aafp.org

American College of Obstetrics and Gynecology
http://www.acog.org

References:

Berman JR, Adhikari SP, Goldstein I. Anatomy and physiology of female sexual function and dysfunction. European Urology. 2000;38:20-29.

Phillips NA. Female sexual dysfunction: evaluation and treatment. Am Fam Physician. Jul 1, 2000;62(1). Available at: http://www.aafp.org/afp/20000701/127.html.

Berman JR, Berman L, Goldstein I. Female sexual dysfunction: incidence, pathophysiology, evaluation, and treatment options. Urology. 1999;54(3):385-391.

The Merck Manual of Diagnosis and Therapy webite. Available at: http://www.merck.com/pubs/mmanual/section18/chapter243/243a.htm. Accessed October 13, 2005.