Female Sexual Dysfunction: Treatment for Women's Sexual Disorders

What’s sexual dysfunction? Sexual dysfunction is a common concern shared by many women. Problems may occur during any phase of the sexual response cycle (excitement, plateau, orgasm, and resolution) that prevent a woman from experiencing sexual satisfaction. Many women are reluctant or embarrassed to discuss their sexual problems, but it's important to tell your doctor what you are experiencing since most cases of female sexual dysfunction can be treated. Female sexual dysfunction may encompass problems with desire, arousal, orgasm, hormones, or pain.

Female sexual dysfunction can have physical or psychological causes. Physical causes include diabetes, heart disease, neurological diseases, hormonal imbalances, menopause, chronic diseases such as kidney disease or liver failure, urinary tract infection, alcoholism, drug abuse, and side effects of medications, including antidepressant drugs. Hormone fluctuations that occur during pregnancy, after childbirth, and menopause may play a role in sexual disorders, too. Psychological causes of sexual dysfunction can include stress, anxiety, concerns about sexual performance, relationship problems, depression, feelings of guilt, and effects of a past sexual trauma.

Both men and women can suffer from sexual dysfunction and sex problems. Seniors may be affected more often, possibly due to health-related declines associated with aging. Males may experience premature ejaculation or delayed ejaculation, problems getting or maintaining an erection, or problems due to low testosterone. Like women, men may also experience problems with desire.

Common types of sexual dysfunction in women include:

• Inhibited sexual desire
• Inability to become aroused
• Lack of orgasm (anorgasmia)
• Painful intercourse

Hormone fluctuations may play a role in female sexual dysfunction. These will be discussed on the following slides.

Lack of sexual desire or lack of interest in sex is inhibited sexual desire. This can have many causes, including hormonal changes, certain medical conditions and treatments, depression, pregnancy, stress, fatigue, lifestyle influences such as work stress or child care, and even boredom with regular sexual routines. Speak with your doctor if you believe medication side effects are contributing to your lack of desire and problems with sexual arousal. Changing your routine may help if lack of desire is a problem. Having sex in new places, at different times of the day, or trying different sexual positions may help reignite desire.

Insufficient vaginal lubrication in women may trigger the inability to become physically aroused during sexual activity. Problems with blood flow to the vagina and clitoris may also affect lubrication and sexual arousal in women. Lubricants may help women become aroused more easily. If a woman is postmenopausal, estrogen cream may help as well.

The absence of sexual climax (orgasm) is called anorgasmia, and it is a common sex issue. Many factors can contribute to anorgasmia, including sexual inhibition, inexperience, or lack of knowledge. Psychological contributors to anorgasmia may include guilt, anxiety, or a past sexual trauma or abuse. Insufficient stimulation, drugs or medications, and chronic diseases can also result in lack of orgasm. Kegel exercises are one potential treatment for lack of orgasm.

Painful intercourse can be a result of a number of conditions such as endometriosis, a pelvic mass, ovarian cysts, vaginitis, poor lubrication, vaginal dryness, the presence of scar tissue from surgery, or a sexually transmitted disease. A painful, involuntary spasm of the muscles that surround the vaginal entrance is a condition called vaginismus that may occur in women who fear penetration will be painful, have sexual phobias, or previous traumatic or painful sexual experiences. Dyspareunia is pain during intercourse or other sexual activity involving penetration or attempted penetration. Pain may be superficial or deep.

Sexual dysfunction in women is diagnosed by a physical exam and symptom history. The doctor will probably perform a pelvic exam with a Pap smear to check for cancer or precancerous changes in the cervix. Other tests may be ordered to rule out medical conditions that may cause female sexual dysfunction. You may also be asked about attitudes toward sex, past sexual trauma or abuse, problems in your relationship, or alcohol and drug abuse to help determine if these psychological factors contribute to the dysfunction. A woman’s age will factor into the possible diagnosis of female sexual dysfunction. The doctor may order lab tests to look for potential physical issues contributing to sexual dysfunction.

Many types of sexual problems can be treated by addressing the underlying physical or psychological problems. Usually it involves cooperation between the woman, her doctors, and therapists. Treatment strategies for sexual dysfunction in women are discussed on the following slides. Involvement of a woman’s sexual partner may be part of the treatment process.

Patient education is important to help women overcome anxiety about sexual function and performance. Learning about sexual behaviors and normal responses may ease anxiety. Knowing about normal anatomy, sexual function, changes that occur during aging, and changes that occur in pregnancy and menopause may help ease a woman’s fears. Women should know they have permission to enjoy sex and sexual experimentation.

It may be necessary to enhance sexual stimulation to help a woman overcome some sexual dysfunction. Masturbation, changing your sexual routine, or use of erotic videos or books may help. Get to know your body and what feels good to you. Tell your partner. Try different sexual positions, have sex at different times of the day, and have sex in new places to discover how to make sex feel better. Schedule sex and make time and energy for the date so you won’t feel rushed or tired.

Anxiety may be alleviated with distraction. Erotic or non-erotic fantasies can be useful. Music, videos, or television can also distract and help women relax. Contracting and relaxing pelvic muscles, similar to the movements one makes during Kegel exercises, can also be a distraction technique.

Other behaviors that do not involve intercourse such as sensual massage may help a woman feel more comfortable with her sexuality and with intercourse and feel less pressure and anxiety surrounding sexual activity. Sensual massage can help a woman feel more comfortable and communicate better with her partner.

If sexual dysfunction is due to pain, sometimes changing sexual positions may help minimize or eliminate the pain. Vaginal lubricants may relieve pain caused by friction, and relaxation before intercourse (warm bath, meditation) may decrease pain responses. Avoiding deep thrusting may help. A doctor may recommend that a woman takes nonsteroidal anti-inflammatory drugs (NSAIDs) prior to having intercourse to minimize pain.

The prognosis for treating sexual dysfunction in women depends on whether the underlying cause can be treated. If sexual dysfunction is related to a treatable physical condition, the outcome is often positive. When dysfunction is due to psychological causes, it can often be treated successfully with counseling, education, and improved communication between partners. If a combination of factors contributes to female sexual dysfunction, all of them need to be addressed to improve the chance of a good outcome.

Hormones play a large role in sexual function in women. As women age, the hormone estrogen decreases, which can lead to poor vaginal lubrication and decreased genital sensation. Low levels of the male hormone testosterone in women may also contribute to reduced sexual arousal, genital sensation, and orgasm. As long as it is not contraindicated, hormone therapy may help women enjoy improved sexual function. Estrogen combats urogenital atrophy, menopausal mood disorders, and vasomotor symptoms, like flushing, which can negatively impact female sexual function.

A hysterectomy (surgical removal of the uterus) may cause sexual dysfunction in many women. Women who have their uterus removed for a benign condition may experience a decrease in sexual responsiveness of up to 30 percent. Hormonal changes associated with removal of the ovaries may result in loss of desire, decreased vaginal lubrication, and genital sensation. Nerves and blood vessels integral to sexual functioning may also be damaged during the surgery. Finally, some women may become depressed or feel a loss of self-esteem from their uterus being removed that may make it hard for them to engage sexually following the procedure.

Menopause and the associated loss of estrogen can affect women's sexual function such as a loss of vaginal lubrication and genital sensation. Other emotional aspects of menopause may contribute to a loss of interest in sex or an inability to become aroused. Loss of estrogen causes thinning and loss of elasticity of the vagina. Estrogen suppositories may help this problem.

However, many postmenopausal women have increased sexual satisfaction. This is thought to be due to less anxiety about getting pregnant, or having the time to relax and enjoy being intimate with their partners.

Sexual problems in women are common, and nearly every woman will experience them on occasion. If the problems persist, they can be very upsetting for a woman and can affect her relationship with her partner. If you experience any sexual problems on a regular basis, talk to your doctor. Help is available! You don't have to suffer in silence and forgo the pleasure of sex.