>> General Info about Female Sexual Dysfunction
Female Sexual dysfunction is an age-related, progressive and highly prevalent problem affecting nearly 30-50 percent 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.
The American Psychological Association (APA) classifies female sexual problems as -
a. Mental disorders - loss of sexual desire or arousal.
b. Discomfort during intercourse.
c. Diminished blood flow to the vagina.
d. Trauma-related aversion to sex.
e. Inability to achieve orgasm.
>>How do you know if you have a problem?
If you don't want to have sex or it never feels good, you might have a sexual problem. The best person to decide if you have a sexual problem is you hence awareness of the problem is important.
>>Types
1. Hypoactive sexual 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. It 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 sexual partner. It is generally a psychological or emotional problem that can be due to various other underlying long standing emotional problems , (for e.g -physical or sexual abuse or childhood trauma).
3. Female sexual arousal disorder -Female sexual arousal disorder When you don't feel a sexual response in your body or you start to respond but can't keep it up. 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 due to certain 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 secondary condition, as a result of surgery, trauma, or hormone deficiencies. Primary orgasm can be secondary to emotional trauma or sexual abuse, however medical/physical factors can certainly contribute to the problem.
6. Vaginismus -Vaginismus is another 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 sexual dysfunction?
The causes of female sexual dysfunction are poorly defined. The reason for this is perhaps because sexual intercourse or stimulation is an act that involves many systems to function in harmony for it to reach the stage of orgasm. To simplify its understanding it is best divided depending on the system that predominates in the dysfunction. Sometimes there may be multiple factors leading to the dysfunction Below are few of the causes that can case sexual dysfunction. The most common are listed first.
* Alcohol
* Anxiety
* Depression - an unhappy relationship or abuse (now or in the past) can also cause sexual problems.
* Emotional problems; distraction
* Illness
* Negative body perception
* Stress- the stresses of everyday life can affect your ability to have sex. Being tired from a busy job or caring for young children may make you feel less desire to have sex.
You may have less sexual desire during pregnancy, right after childbirth or when you are breast-feeding. After menopause many women feel less sexual desire, have vaginal dryness or have pain during sex.
Some medical causes could be:
* Drugs and medications; birth control pill Smoking
* Spinal cord injury (can cause nerve damage; paralysis)
* Rarely - Bicycle riding (long narrow seats associated with perineal pressure and reduced blood flow)
* Surgery (of or near reproductive-urinary system or abdomen; may damage nerves)
* Urinary incontinence (can cause embarrassment, avoidance)
* Vaginal atrophy
* Vascular causes
* High blood pressure
* High cholesterol levels
* Diabetes
* Smoking
* Heart disease.
Any traumatic injury to the to the genitals or pelvic region, such as pelvic fractures, blunt trauma, surgical disruption, extensive bike riding, for instance, can result in diminished vaginal and clitoral blood flow and complaints of sexual dysfunction.
Neurological causes :
Spinal cord injury or disease of the central or peripheral nervous system. Women with spinal cord injury have significantly more difficulty achieving orgasm than able-bodied women. Hormonal/Endocrine causes:
* Dysfunction of the hypothalamic/pituitary axis.
* Surgical or medical castration.
* Natural menopause.
* Premature ovarian failure.
* Chronic birth control pills .
Hormonally based female sexual dysfunction 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.
Dissatisfaction theory
In some instances it is neither psychological nor medical. A great deal of women's sexual dysfunction is not caused by hormone deficiency or diminished pelvic blood flow; it results from inadequate genital stimulation. Poor communication by both 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.
Psychogenic
Emotional and relational issues are also found to significantly effect sexual arousal.
* Self-esteem
* Body image
* Relationship with partner
* Ability to communicate ones sexual needs with ones partner
* Psychological disorders such as depression, obsessive compulsive disorder, anxiety disorder, etc., are associated with female sexual dysfunction.
* Medications - Antidepressants and benzodiazepines used to treat depression and anxiety are the drugs most commonly associated with loss of libido and inability to achieve orgasm.
>>What are the diagnostic Tests that might be done?
These are not undertaken commonly. However more recently a few investigations are available.
1) Vagnial pH testing :It is commonly performed by gynecologists and urologists to detect bacteria-causing vaginitis. A probe is inserted into the vagina which takes the reading. Decreasing hormone levels and diminished vaginal secretion associated with menopause cause a rise in pH (over 5), which is easily detected with the test.
2) Vaginal photoplethysmography :It is used to measure Vaginal blood flow and engorgement (pooling and swelling of vaginal tissue). For the procedure an acrylic tampon-shaped instrument inserted in the vagina and it uses reflected light to sense flow and temperature.
3) Biothesiometer :A small cylindrical instrument, may be used to assess the sensitivity of the clitoris and labia to pressure and temperature.
>>What are the treatment options available?
There are three primary types of treatment for female sexual dysfunction:
When blood flow, hormone levels, and sexual anatomy are normal - Education on female anatomy, arousal and response can help.
When there is hormonal dysfunction (especially in post menopausal women) - Hormone replacement therapy can be considered and is found to be helpful.
When there is a vascular or Blood flow problem - Vascular treatment may be required.
