Female Sexual Dysfunction

Women experience problems with sexual function at some point in their lives. Sexual dysfunction is quite common affecting almost 30-50% of women globally.Sexual activity incorporates interpersonal relationships, each partner bringing unique attitudes, needs and responses into the coupling. A breakdown in any of these areas may lead to sexual dysfunction. This can be a lifelong problem, or it can happen later in life.

Female sexual dysfunction may be due to a number of causes. Traumatic injury to the genitals or pelvic region, surgical intervention, extensive bike riding, underlying medical conditions, hormonal imbalance, and medications can cause sexual dysfunction.

The American Psychological Association (APA) classifies female sexual problems as-

Mental disorder - loss of sexual desire or arousal

Discomfort during intercourse

Diminished blood flow to the vagina

Trauma-related aversion to sex

Inability to achieve orgasm

Almost all causes of sexual dysfunction are treatable. Communicating the concerns and understanding ones’ body and its normal response to sexual activity are important steps toward gaining sexual satisfaction.

What are the Types of Female Sexual Dysfunction?

Types of female sexual disorder are-

1. Hypoactive sexual desire disorder

Hypoactive sexual desire disorder is characterized by an absence of libido or the intrinsic lack of desire to have sexual relationship. Persistent or recurring deficiency (or absence) of sexual fantasies/thoughts and sexual activity may sometimes cause personal distress.

Hypoactive sexual disorder may also result from psychological/emotional factors or be secondary to medical problems such as hormone deficiencies, and medical or surgical interventions. Any disruption of the female hormonal system caused by natural menopause, surgically or medically-induced menopause; or endocrine disorders can also result in inhibited sexual desire.

2. Sexual aversion disorder

Sexual aversion disorder is characterized by an aversion to or avoidance or dismissal of sexual contact with a partner.

It is generally a psychological or emotional problem that can be due to various other underlying long-standing emotional problems like physical or sexual abuse or childhood trauma.

3. Female sexual arousal disorder

Female sexual arousal disorder is when a female does not feel a sexual response in the body or is unable to keep up the arousal.

Some disorders of arousal include lack of or diminished vaginal lubrication, decreased clitoral and labial sensation, decreased clitoral and labial engorgement or lack of vaginal smooth muscle relaxation. These conditions may occur secondary to psychological factors; however often there is a medical/physiologic basis such as diminished vaginal/clitoral blood flow, previous injury or fracture to pelvic bones, pelvic surgery or sometimes it is a result of medications.

4. Female orgasmic disorder

Female orgasmic disorder is defined as the delay or absence of orgasm after ‘normal’ arousal.

This may be a primary (never achieved orgasm) or a secondary condition, as a result of surgery, trauma, or hormone deficiencies. Primary orgasm can be due to emotional trauma or sexual abuse. Medical and/or physical factors can certainly contribute to the problem.

5. Dyspareunia

Dyspareunia is a medical term that indicates genital pain before, during, or after intercourse. In some women, the muscles in the outer part of the vagina tighten when they start to have sex leading to the discomfort.

Dyspareunia can also develop secondary to medical problems such as vestibulitis (inflammation of a gland in the genital area), vaginal atrophy or dryness of vagina or vaginal infection. Dyspareunia can also be either physiological or psychological, or a combination of the two.

6. Vaginismus

Vaginismus is a medical term that indicates recurrent or persistent involuntary spasm of the musculature of the outer third the vagina and this interferes with vaginal penetration.

Vaginismus usually develops as a conditioned response to painful penetration, or secondary to psychological/emotional factors.

What are the Causes of Female Sexual Dysfunction?

The causes of female sexual dysfunction are poorly defined. This is perhaps because sexual intercourse or stimulation is an act that involves many systems to function in harmony to reach the stage of orgasm. Sometimes there may be multiple factors leading to the dysfunction.

The causes of female sexual dysfunction are listed below:

Medical causes -: These include

Spinal cord injury. Spinal cord injury can cause nerve damage or paralysis. Women with spinal cord injury have significantly more difficulty achieving orgasm than able-bodied women.

Bicycle riding. Bicycle riding on long narrow seats is associated with perineal pressure and reduced vaginal and clitoral blood flow and can rarely cause sexual dysfunction.

Surgery. Surgery of or near the reproductive system, urinary system or abdomen may damage nerves and lead to sexual dysfunction.

Urinary incontinence. Urinary incontinence can cause embarrassment and avoidance of sex.

Vaginal atrophy. Vaginal atrophy can cause discomfort during intercourse.

Systemic diseases like hypertension, high cholesterol levels, diabetes and heart disease can also cause sexual dysfunction.

Hormonal/Endocrine causes- Female sexual dysfunction due to hormonal problems can lead to decreased desire and libido, vaginal dryness and lack of sexual arousal.

Estrogen, a primarily female hormone, is associated with sexual desire. Testosterone, a primarily male sex hormone, plays a role in women's sexual development and function, including sensitivity of the breasts and clitoris. Some women experience diminished sexual desire, absence of sexual fantasies, and impaired sensitivity following menopause or hysterectomy or due to aging as a result of reduced estrogen.

Hormonal abnormalities may arise due to-

Dysfunction of the hypothalamic/pituitary axis

Surgical or medical castration

Natural menopause- After menopause many women feel less sexual desire, have vaginal dryness or have pain during sex.

Premature ovarian failure

Pregnancy- the sexual desire may be less during pregnancy, right after childbirth or while breast-feeding.

Psychogenic causes-: These include

Emotional and relationship issues

Self-esteem

Negative body perception

Inability to communicate one’s sexual needs with one’s partner

Depression, obsessive compulsive disorder, anxiety disorder

Stress- Stress can affect a person’s ability to have sex. Being tired from a busy job or caring for young children may make the person feel less desire to have sex.

Other causes: Other causes include:

Excessive alcohol intake and smoking

Medications- Certain birth control pills can lead to decreased libido. Antidepressants and benzodiazepines used to treat depression and anxiety are associated with loss of libido and inability to achieve orgasm.

Dissatisfaction theory-

In some instances a woman's sexual dysfunction is due to inadequate genital stimulation.
Poor communication between partners may result in men not knowing how to stimulate a woman so that she becomes aroused. This leads to unsatisfactory sex and can cause arousal problems, lack of sexual interest, depression, and aversion to sex.