Female sexual dysfunction is a broad term for sexual problems in women, which fall into five categories that often overlap with each other:
1. Low desire
Some women have little or no interest in sex until they engage in sexual activity, at which point they become aroused. Sexual dysfunction occurs when a woman:
- Lacks interest in any sexual behavior, including masturbation
- Has few or no sexual fantasies, ideas, or dreams
- Is worried about her lack of sex drive
- Does not want to initiate sexual intercourse with her partner
- Does not experience pleasure during sexual intercourse
2. Lack of arousal
Women may have difficulty becoming or being physically aroused, even if they are interested in sex. Some women who have this porblem don't produce enough vaginal lubricant for sexual activity. This could be attributed to various causes, both physical and psychological.
3. Difficulty reaching orgasm
Some women never have orgasms or reach climax during sexual intercourse. Other women may want to have orgasms but have never had orgasms before and are unable to reach climax. In some cases, women may find that their orgasms are not as intense as they used to be.
4. Pain during sex
Some women experience pain when they have vaginal intercourse. This may be due to lack of lubrication, cervical erosion, or anxiety issues.
5. Drug-related sexual dysfunction
Some women experience sexual problems shortly after taking or stopping certain drugs. The following drugs have the potential to causesex problems:
- Anticholinergic medications
- Birth control pills
- Blood pressure medications such as beta blockers
- Selective serotonin reuptake inhibitors
What factors contribute to sexual dysfunction?
Sexual behavior is a uniqe combination of physiological, anatomical, and psychosocial factors that vary from person to person. The first step toward understanding sexual dysfunction is to establish a baseline of expected anatomic and physiologic responses to sexual stimulation in healthy people.
Factors that can lead to female sexual dysfunction include:
- Physical: Sexual dysfunction can be caused by medical conditions such as cancer, kidney failure, multiple sclerosis, heart disease, and bladder problems.
- Hormonal: After menopause, lower estrogen levels may cause changes in your genital tissues and sexual responsiveness. A decrease in estrogen causes a decrease in blood flow to the pelvic region, which can result in less genital sensation, making it more difficult to build arousal and reach orgasm. With age, the vaginal lining thins and loses elasticity, especially if you are not sexually active. These factors can result in dyspareunia (painful intercourse). Hormone levels in your body change after giving birth and during breastfeeding, which can cause vaginal dryness and affect your desire to have sex.
- Psychological and social: Untreated anxiety or depression, as well as long-term stress and a history of sexual abuse, can cause or contribute to sexual dysfunction. Pregnancy worries and the demands of being a new mother may have similar effects. Long-standing disagreements with your partner about sex or other aspects of your relationship can reduce your sexual responsiveness. Cultural and religious issues, as well as body image issues, can also play a role.
Risk factors of female sexual problems include:
- Depression or anxiety
- Heart and blood vessel disease
- Neurological conditions, such as spinal cord injury or multiple sclerosis
- Gynecological conditions, such as vulvovaginal atrophy, infections, or lichen sclerosis
- Certain medications, such as antidepressants or high blood pressure medications
- Emotional or psychological stress, especially about your relationship with your partner
- History of sexual abuse
How are female sexual problems diagnosed?
Individuals or their partners may become aware of sexual problems before talking to a doctor. Your doctor may confirm a diagnosis by:
- Taking your medical history followed by a thorough physical examination
- Determining whether there are any predisposing illnesses or physical conditions
- Determining whether there are any fears, anxieties, or guilt associated with sexual behaviors or performance
- Determining whether there is a history of prior sexual trauma
- Performing a pelvic exam if you are in pain
- Examining you for signs of infection through urine tests or cervical or vaginal fluid tests
What are the treatment options for female sexual problems?
Treatment of female sexual problems varies greatly due to the wide range of possible symptoms and causes. Women with sexual concerns often benefit from a multifaceted treatment approach.
Nonmedical treatment of female sexual dysfunction
- Communication: Open communication with your partner can make a huge difference in your sexual satisfaction. Even if you're not used to discussing your likes and dislikes, learning to do so and providing feedback in a nonthreatening manner sets the stage for greater intimacy.
- Lifestyle habits: Consume alcohol in moderation, as too much alcohol can reduce your sexual responsiveness. Regular physical activity can boost your stamina and elevate your mood, which can help enhance sexual desire. Practice stress-reduction techniques to help you enjoy your sexual experiences.
- Counseling: Consult a therapist or counselor who specializes in sexual issues. They may help you learn ways to optimize your body's sexual responses and improve intimacy with your partner through reading materials or couples exercises.
- Lubricants: If you experience vaginal dryness or pain during sex, a vaginal lubricant may help.
- Devices: Arousal can be increased by stimulating the clitoris. To provide clitoral stimulation, try using a vibrator or other sex toys.
Medical treatment for female sexual dysfunction
- Estrogen therapy: Localized estrogen therapy comes in the form of vaginal rings, creams, or tablets. This therapy improves sexual function by increasing vaginal blood flow and lubrication, as well as improving vaginal tone and elasticity. Risks of hormone therapy vary depending on your age, risk of other health problems such as heart and blood vessel disease, and the dose and type of hormone used.
- Osphena (ospemifene): This medication works by selectively modulating estrogen receptors. It alleviates pain during sex for women suffering from pain during sex.
- Androgen therapy: Androgens include testosterone. Although testosterone levels in women are much lower than those in men, testosterone plays a role in healthy sexual function in both men and women. Androgen therapy for sexual dysfunction is divisive, however. Some studies show benefits for women who have low testosterone levels and develop sexual dysfunction, whereas others show little or no benefit.
- Addyi (flibanserin): Originally developed as an antidepressant, flibanserin is now approved by the FDA as a treatment option for premenopausal women with low sexual desire. Addyi, a daily pill, may aso increase sex drive in women who have low sexual desire. Low blood pressure, sleepiness, nausea, fatigue, dizziness. and fainting are potential side effects, especially if the drug is combined with alcohol. If you haven't noticed an improvement in your sex drive after 8 weeks, experts advise discontinuing use.
- Vyleesi (bremelanotide): Another FDA-approved treatment for low sexual desire in premenopausal women is bremelanotide. This medication is injected just under the skin in the abdomen or thigh prior to sexual activity. Some women experience nausea, which is more common after the first injection but usually goes away after the second. Other side effects include nausea, flushing, headache, and a skin reaction at the injection site.
Potential treatments that need more research
Phosphodiesterase inhibitors: This class of drugs is effective in treating erectile dysfunction in men, but it does not work nearly as well in treating female sexual dysfunction. Studies on the efficacy of these drugs in women have yielded inconclusive results.
- Revatio and Viagra (sildenafil): This drug is helpful for some women with sexual dysfunction because of taking selective serotonin reuptake inhibitors, a class of drugs used to treat depression. If you take nitroglycerin for angina (chest pain caused by reduced blood flow to the heart), do not take sildenafil.
- Herbal supplements: Herbal supplements and topical oils that claim to boost libido and sexual pleasure have not been thoroughly researched. Before using any herbal or topical oil formulations, consult your doctor.
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Female Sexual Dysfunction: Therapeutic Options and Experimental Challenges: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3008577/
Types and Causes of Female Sexual Dysfunction: https://www.bidmc.org/centers-and-departments/obstetrics-and-gynecology/programs-and-services/gynecology/programs-services/center-for-intimate-health-and-wellness/types-of-female-sexual-dysfunction
Female Sexual Dysfunction: https://emedicine.medscape.com/article/2500107-overview
Female sexual dysfunction: classification, pathophysiology, and management: https://www.fertstert.org/article/S0015-0282(07)03561-3/fulltext
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