Female sexual dysfunction
Persistent, recurrent problems with sexual response or desire — that distress you or strain your relationship with your partner — are known medically as female sexual dysfunction.
Many women experience problems with sexual function at some point in their lives. Female sexual dysfunction can occur at all stages of life, and it may be ongoing or happen only once in a while.
You may experience more than one type of female sexual dysfunction. Types include:
Low sexual desire. You have diminished libido, or lack of sex drive.Sexual arousal disorder. Your desire for sex might be intact, but you have difficulty or are unable to become aroused or maintain arousal during sexual activity.Orgasmic disorder. You have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.Sexual pain disorder. You have pain associated with sexual stimulation or vaginal contact.
Sexual response involves a complex interaction of physiology, emotions, experiences, beliefs, lifestyle and relationships. Disruption of any of these components can affect sexual drive, arousal or satisfaction. Fortunately, female sexual dysfunction is treatable.
SYMPTOMS
Female sexual dysfunction can happen at any age. Sexual problems often develop when your hormones are in flux — for example, after having a baby or during menopause. Sexual concerns may also occur with major illness, such as cancer, diabetes, or heart and blood vessel (cardiovascular) disease.
Your problems might be classified as female sexual dysfunction if you experience one or more of the following — and you're distressed about it:
Your desire to have sex is low or absent.You can't maintain arousal during sexual activity, or you don't become aroused despite a desire to have sex.You can't experience an orgasm.You have pain during sexual contact.
CAUSES
Several factors contribute to sexual dissatisfaction or dysfunction. These factors tend to be interrelated.
Physical. Examples of physical conditions that may contribute to sexual problems include arthritis, urinary or bowel difficulties, pelvic surgery, fatigue, headaches, other pain problems, and neurological disorders such as multiple sclerosis. Certain medications, including some antidepressants, blood pressure medications, antihistamines and chemotherapy drugs, can decrease your sex drive and your body's ability to experience orgasm.
Hormonal. Lower estrogen levels after menopause may lead to changes in your genital tissues and sexual responsiveness. The folds of skin that cover your genital area (labia) become thinner, exposing more of the clitoris. This increased exposure sometimes reduces the sensitivity of the clitoris.
The vaginal lining also becomes thinner and less elastic, particularly if you're not sexually active, causing a need for more stimulation to relax and lubricate before intercourse. These factors can lead to painful intercourse (dyspareunia), and it may take longer to experience orgasm.
Your body's hormone levels also shift after giving birth and during breast-feeding, which can lead to vaginal dryness and can affect your desire to have sex.
Psychological and social. Untreated anxiety or depression can cause or contribute to sexual dysfunction, as can long-term stress. The worries of pregnancy and demands of being a new mother may have similar effects. Longstanding conflicts with your partner — about sex or other aspects of your relationship — can diminish your sexual responsiveness as well. Cultural and religious issues and problems with body image also may contribute.
Emotional distress can be both a cause and a result of sexual dysfunction. Regardless of where the cycle began, you usually need to address relationship issues for treatment to be effective.
COMPLICATIONS
Persistent, recurrent problems with sexual response or desire — that distress you or strain your relationship with your partner — are known medically as female sexual dysfunction.
Many women experience problems with sexual function at some point in their lives. Female sexual dysfunction can occur at all stages of life, and it may be ongoing or happen only once in a while.
You may experience more than one type of female sexual dysfunction. Types include:
Low sexual desire. You have diminished libido, or lack of sex drive.Sexual arousal disorder. Your desire for sex might be intact, but you have difficulty or are unable to become aroused or maintain arousal during sexual activity.Orgasmic disorder. You have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.Sexual pain disorder. You have pain associated with sexual stimulation or vaginal contact.
Sexual response involves a complex interaction of physiology, emotions, experiences, beliefs, lifestyle and relationships. Disruption of any of these components can affect sexual drive, arousal or satisfaction. Fortunately, female sexual dysfunction is treatable.
DIAGNOSIS
To diagnose female sexual dysfunction, your doctor will:
Discuss your sexual and medical history. You might be uneasy talking with your doctor about such personal matters, but your sexuality is a key part of your well-being. The more forthcoming you can be about your sexual history and current problems, the better your chances of finding an effective approach to treating them.Perform a pelvic exam. During the exam, your doctor checks for physical changes that affect your sexual enjoyment, such as thinning of your genital tissues, decreased skin elasticity, scarring or pain.
Your doctor may also refer you to a counselor or therapist specializing in sexual and relationship problems.
TREATMENT
Female sexual dysfunction has many possible symptoms and causes, so treatment varies. Communicating your concerns and understanding your body and its normal response to sexual activity are important steps toward gaining sexual satisfaction.
Women with sexual concerns most often benefit from a combined treatment approach that addresses medical as well as relationship and emotional issues.
Nonmedical treatment for female sexual dysfunction
To treat sexual dysfunction, your doctor might recommend that you start with nonmedical strategies:
Talk and listen. Open, honest communication with your partner makes a world of difference in your sexual satisfaction. Even if you're not used to talking about your likes and dislikes, learning to do so and providing feedback in a nonthreatening way sets the stage for greater intimacy.Practice healthy lifestyle habits. Go easy on alcohol — drinking too much can blunt your sexual responsiveness. Stop smoking — smoking restricts blood flow to your sexual organs, decreasing sexual arousal. Be physically active — regular physical activity can increase your stamina and elevate your mood, enhancing romantic feelings. Learn ways to decrease stress so you can focus on and enjoy your sexual experience.Seek counseling. Talk with a counselor or therapist who specializes in sexual and relationship problems. Therapy often includes education about how to optimize your body's sexual response, ways to enhance intimacy with your partner, and recommendations for reading materials or couples exercises.Use a lubricant. A vaginal lubricant may be helpful during intercourse if you experience vaginal dryness or pain during sex.Try a device. Arousal improves with stimulation of the clitoris. Use a vibrator to provide clitoral stimulation. Although some women find clitoral vacuum suction devices helpful for enhancing sexual arousal, those devices can be cumbersome.
Medical treatment for female sexual dysfunction
Effective treatment for sexual dysfunction often requires addressing an underlying medical condition or hormonal change.
To treat sexual dysfunction tied to an underlying medical condition, your doctor might recommend that you:
Adjust or change medication that has sexual side effectsTreat a thyroid problem or other hormonal conditionOptimize treatment for depression or anxietyTry strategies for relieving pelvic pain or other pain problems
Treating female sexual dysfunction linked to a hormonal cause might include:
Estrogen therapy. Localized estrogen therapy comes in the form of a vaginal ring, cream or tablet. This therapy benefits sexual function by improving vaginal tone and elasticity, increasing vaginal blood flow and enhancing lubrication. Androgen therapy. Androgens include male hormones, such as testosterone. Testosterone plays a role in healthy sexual function in women as well as men, although women have much lower amounts of testosterone. Androgen therapy for sexual dysfunction is controversial, however. Some studies show a benefit for women who have low testosterone levels and develop sexual dysfunction; other studies show little or no benefit.
The risks of hormone therapy may vary, depending on whether estrogen is given alone or with a progestin, your age, the dose and type of hormone, and health issues such as your risks of heart and blood vessel disease and cancer. Talk with your doctor about benefits and risks. In some cases, hormonal therapy might require close monitoring by your doctor.
Potential treatments that need more research
More research is needed before these agents might be recommended for treatment of female sexual dysfunction:
Tibolone. Tibolone is a synthetic steroid drug currently used in Europe and Australia for treatment of postmenopausal osteoporosis. In one randomized trial, postmenopausal women taking the drug experienced an improvement in overall sexual function and a reduction in personal distress compared with postmenopausal women taking estrogen, but the effect was small. Due to concerns over increased risk of breast cancer and stroke in women taking tibolone, the drug isn't approved by the Food and Drug Administration for use in the U.S. Phosphodiesterase inhibitors. This group of medications has proved successful in treating erectile dysfunction in men, but the drugs don't work nearly as well in treating female sexual dysfunction. Studies looking into the effectiveness of these drugs in women show inconsistent results. One drug, sildenafil (Viagra), may prove beneficial for some women who experience sexual dysfunction as a result of taking selective serotonin reuptake inhibitors (SSRIs), a class of drugs used to treat depression. However, don't take sildenafil if you use nitroglycerin for angina — a type of chest pain caused by reduced blood flow to the heart.
Issues surrounding female sexual dysfunction are usually complex, so even the best medications aren't likely to work if other emotional or social factors remain unresolved.
Persistent, recurrent problems with sexual response or desire — that distress you or strain your relationship with your partner — are known medically as female sexual dysfunction.
Many women experience problems with sexual function at some point in their lives. Female sexual dysfunction can occur at all stages of life, and it may be ongoing or happen only once in a while.
You may experience more than one type of female sexual dysfunction. Types include:
Low sexual desire. You have diminished libido, or lack of sex drive.Sexual arousal disorder. Your desire for sex might be intact, but you have difficulty or are unable to become aroused or maintain arousal during sexual activity.Orgasmic disorder. You have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.Sexual pain disorder. You have pain associated with sexual stimulation or vaginal contact.
Sexual response involves a complex interaction of physiology, emotions, experiences, beliefs, lifestyle and relationships. Disruption of any of these components can affect sexual drive, arousal or satisfaction. Fortunately, female sexual dysfunction is treatable.
SYMPTOMS
Female sexual dysfunction can happen at any age. Sexual problems often develop when your hormones are in flux — for example, after having a baby or during menopause. Sexual concerns may also occur with major illness, such as cancer, diabetes, or heart and blood vessel (cardiovascular) disease.
Your problems might be classified as female sexual dysfunction if you experience one or more of the following — and you're distressed about it:
Your desire to have sex is low or absent.You can't maintain arousal during sexual activity, or you don't become aroused despite a desire to have sex.You can't experience an orgasm.You have pain during sexual contact.
CAUSES
Several factors contribute to sexual dissatisfaction or dysfunction. These factors tend to be interrelated.
Physical. Examples of physical conditions that may contribute to sexual problems include arthritis, urinary or bowel difficulties, pelvic surgery, fatigue, headaches, other pain problems, and neurological disorders such as multiple sclerosis. Certain medications, including some antidepressants, blood pressure medications, antihistamines and chemotherapy drugs, can decrease your sex drive and your body's ability to experience orgasm.
Hormonal. Lower estrogen levels after menopause may lead to changes in your genital tissues and sexual responsiveness. The folds of skin that cover your genital area (labia) become thinner, exposing more of the clitoris. This increased exposure sometimes reduces the sensitivity of the clitoris.
The vaginal lining also becomes thinner and less elastic, particularly if you're not sexually active, causing a need for more stimulation to relax and lubricate before intercourse. These factors can lead to painful intercourse (dyspareunia), and it may take longer to experience orgasm.
Your body's hormone levels also shift after giving birth and during breast-feeding, which can lead to vaginal dryness and can affect your desire to have sex.
Psychological and social. Untreated anxiety or depression can cause or contribute to sexual dysfunction, as can long-term stress. The worries of pregnancy and demands of being a new mother may have similar effects. Longstanding conflicts with your partner — about sex or other aspects of your relationship — can diminish your sexual responsiveness as well. Cultural and religious issues and problems with body image also may contribute.
Emotional distress can be both a cause and a result of sexual dysfunction. Regardless of where the cycle began, you usually need to address relationship issues for treatment to be effective.
COMPLICATIONS
Persistent, recurrent problems with sexual response or desire — that distress you or strain your relationship with your partner — are known medically as female sexual dysfunction.
Many women experience problems with sexual function at some point in their lives. Female sexual dysfunction can occur at all stages of life, and it may be ongoing or happen only once in a while.
You may experience more than one type of female sexual dysfunction. Types include:
Low sexual desire. You have diminished libido, or lack of sex drive.Sexual arousal disorder. Your desire for sex might be intact, but you have difficulty or are unable to become aroused or maintain arousal during sexual activity.Orgasmic disorder. You have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.Sexual pain disorder. You have pain associated with sexual stimulation or vaginal contact.
Sexual response involves a complex interaction of physiology, emotions, experiences, beliefs, lifestyle and relationships. Disruption of any of these components can affect sexual drive, arousal or satisfaction. Fortunately, female sexual dysfunction is treatable.
DIAGNOSIS
To diagnose female sexual dysfunction, your doctor will:
Discuss your sexual and medical history. You might be uneasy talking with your doctor about such personal matters, but your sexuality is a key part of your well-being. The more forthcoming you can be about your sexual history and current problems, the better your chances of finding an effective approach to treating them.Perform a pelvic exam. During the exam, your doctor checks for physical changes that affect your sexual enjoyment, such as thinning of your genital tissues, decreased skin elasticity, scarring or pain.
Your doctor may also refer you to a counselor or therapist specializing in sexual and relationship problems.
TREATMENT
Female sexual dysfunction has many possible symptoms and causes, so treatment varies. Communicating your concerns and understanding your body and its normal response to sexual activity are important steps toward gaining sexual satisfaction.
Women with sexual concerns most often benefit from a combined treatment approach that addresses medical as well as relationship and emotional issues.
Nonmedical treatment for female sexual dysfunction
To treat sexual dysfunction, your doctor might recommend that you start with nonmedical strategies:
Talk and listen. Open, honest communication with your partner makes a world of difference in your sexual satisfaction. Even if you're not used to talking about your likes and dislikes, learning to do so and providing feedback in a nonthreatening way sets the stage for greater intimacy.Practice healthy lifestyle habits. Go easy on alcohol — drinking too much can blunt your sexual responsiveness. Stop smoking — smoking restricts blood flow to your sexual organs, decreasing sexual arousal. Be physically active — regular physical activity can increase your stamina and elevate your mood, enhancing romantic feelings. Learn ways to decrease stress so you can focus on and enjoy your sexual experience.Seek counseling. Talk with a counselor or therapist who specializes in sexual and relationship problems. Therapy often includes education about how to optimize your body's sexual response, ways to enhance intimacy with your partner, and recommendations for reading materials or couples exercises.Use a lubricant. A vaginal lubricant may be helpful during intercourse if you experience vaginal dryness or pain during sex.Try a device. Arousal improves with stimulation of the clitoris. Use a vibrator to provide clitoral stimulation. Although some women find clitoral vacuum suction devices helpful for enhancing sexual arousal, those devices can be cumbersome.
Medical treatment for female sexual dysfunction
Effective treatment for sexual dysfunction often requires addressing an underlying medical condition or hormonal change.
To treat sexual dysfunction tied to an underlying medical condition, your doctor might recommend that you:
Adjust or change medication that has sexual side effectsTreat a thyroid problem or other hormonal conditionOptimize treatment for depression or anxietyTry strategies for relieving pelvic pain or other pain problems
Treating female sexual dysfunction linked to a hormonal cause might include:
Estrogen therapy. Localized estrogen therapy comes in the form of a vaginal ring, cream or tablet. This therapy benefits sexual function by improving vaginal tone and elasticity, increasing vaginal blood flow and enhancing lubrication. Androgen therapy. Androgens include male hormones, such as testosterone. Testosterone plays a role in healthy sexual function in women as well as men, although women have much lower amounts of testosterone. Androgen therapy for sexual dysfunction is controversial, however. Some studies show a benefit for women who have low testosterone levels and develop sexual dysfunction; other studies show little or no benefit.
The risks of hormone therapy may vary, depending on whether estrogen is given alone or with a progestin, your age, the dose and type of hormone, and health issues such as your risks of heart and blood vessel disease and cancer. Talk with your doctor about benefits and risks. In some cases, hormonal therapy might require close monitoring by your doctor.
Potential treatments that need more research
More research is needed before these agents might be recommended for treatment of female sexual dysfunction:
Tibolone. Tibolone is a synthetic steroid drug currently used in Europe and Australia for treatment of postmenopausal osteoporosis. In one randomized trial, postmenopausal women taking the drug experienced an improvement in overall sexual function and a reduction in personal distress compared with postmenopausal women taking estrogen, but the effect was small. Due to concerns over increased risk of breast cancer and stroke in women taking tibolone, the drug isn't approved by the Food and Drug Administration for use in the U.S. Phosphodiesterase inhibitors. This group of medications has proved successful in treating erectile dysfunction in men, but the drugs don't work nearly as well in treating female sexual dysfunction. Studies looking into the effectiveness of these drugs in women show inconsistent results. One drug, sildenafil (Viagra), may prove beneficial for some women who experience sexual dysfunction as a result of taking selective serotonin reuptake inhibitors (SSRIs), a class of drugs used to treat depression. However, don't take sildenafil if you use nitroglycerin for angina — a type of chest pain caused by reduced blood flow to the heart.
Issues surrounding female sexual dysfunction are usually complex, so even the best medications aren't likely to work if other emotional or social factors remain unresolved.
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