Female Sexual Dysfunction
Definition:
Female sexual dysfunction is a chronic disturbance in the sexual response cycle.
Causes:
The sexual response cycle consists of three stages: desire, arousal, and orgasm. It relies on mental stimulation, nerve signals, hormones, and blood flow. Sexual dysfunction can arise if any of these processes are disturbed.
Sexual dysfunctions include:
Hypoactive sexual desire disorder - low sexual desire. Causes include conditions or medications that interfere with nerve signals, such as:
- Hormone deficiencies
- Neuropsychiatric disorders
Sexual aversion disorder - strong desire to avoid sexual activity. Caused primarily by psychological factors stemming from traumatic experiences, such as:
- Childhood sexual abuse
- Painful sexual experiences
- Feelings of shame and guilt
Female sexual arousal disorder - inability to attain or maintain a physical response to sexual arousal. Physical causes include conditions and medications that interfere with nerve signals or blood flow, such as:
- Diabetes
- Arteriosclerosis
- Medications, including many blood pressure and psychiatric drugs
Female orgasmic disorder - inability to achieve orgasm or delayed orgasm. Physical causes include:
- Surgery
- Hormone deficiencies
- Certain medications, including antidepressants
Dyspareunia - pain during sexual intercourse. Physical causes include:
- Insufficient vaginal lubrication
- Inflammation of the bladder (cystitis)
- Endometriosis
- Vaginal or pelvic infections
Vaginismus - painful spasms of the muscles of the vagina preventing intercourse. Physical causes include:
- Vaginal scarring from previous injuries, surgeries, or childbirth
- Vaginal irritation or inflammation from douches, spermicides, or latex condoms
- Vaginal infection
Psychological causes -
- Sexual guilt.
- Grief
- Trauma
- Depression
- Interpersonal conflict with a sexual partner
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition.
Medical conditions and diseases:
- Arteriosclerosis
- Autoimmune disorders
- Cancer
- Diabetes
- High blood pressure
- Endocrine disorders
- Nerve disorders (i.e., multiple sclerosis, peripheral neuropathy, stroke)
- Sexually transmitted diseases
- Skin disorders (i.e., eczema, contact dermatitis)
- Spinal cord injury
- Urinary tract infections
Gynecologic disorders, procedures, and changes:
- Bladder or uterine prolapse
- Hysterectomy
- Oophorectomy (removal of one or both of the ovaries)
- Mastectomy
- Endometriosis
- Uterine fibroids
- Vaginitis
- Complications of gynecologic surgery
- Pregnancy and post-partum period
- Lactation
- Menopause
Medications:
- Antidepressants
- Antipsychotics
- Antiepileptics
- Antihistamines
- Antihypertensives and other cardiac medications
- Anabolic steroids
- Antianxiolytics
- Narcotics
- Alcohol
- Oral contraceptives
- Smoking
- Cancer chemotherapy
Psychological and social conditions:
- Life stressors
- Anxiety or depression
- Grief
- Guilt
- Rape
- Interpersonal conflict with a sexual partner
- Sexual identity conflicts
Symptoms:
Symptoms of sexual dysfunction include:
- Loss of desire
- Lack of lubrication
- Lack of clitoral/vaginal sensation
- Delayed orgasm
- Pain during intercourse
- Involuntary vaginal contraction that inhibits penetration
Diagnosis:
Your doctor will ask about your symptoms, medical history and the medications you take. Your doctor will also conduct a gynecologic exam.
Tests may include:
- Swabs of vaginal fluid to evaluate for infection or bacterial imbalance
- Cervical swabs to test for sexually transmitted diseases (STDs)
- Urine tests
- Blood tests
If psychological issues are involved, the doctor may refer you to a:
- Psychiatrist
- Psychologist
- Sex therapist
Treatment:
Treatment depends on whether the cause of the sexual dysfunction is correctable. If not, the doctor may recommend behavioral techniques to enhance sexual desire and decrease discomfort.
Treatments may include:
Eros - a "clitoris pump" that uses a suction cup and hand-held vacuum device to increase blood flow to the clitoris
Estrogen Replacement Therapy (ERT) - to increase libido, improve clitoral sensation, and decrease pain during intercourse for women in menopause. For women with other estrogen-depleting conditions, topical estrogen cream and Estring can also help with vaginal irritation, pain, or dryness.
Testosterone - used most effectively in menopausal women to increase libido and clitoral sensitivity
Lubricants - vaginal lubricants to relieve dyspareunia, vaginal dryness, and irritation. These are available over the counter.
Vaginal Dilators - inserted into the vagina for 15 minutes, twice daily, to treat vaginismus
Pelvic Exercises - Kegel exercises and techniques to relax the vaginal muscles and relieve orgasmic disorders and vaginismus
Prevention:
You can't avoid all the risk factors for female sexual dysfunction. However, the steps below will help you avoid certain risk factors.
- If a medical condition is the cause, follow the treatment.
- If medications are the problem, ask your doctor about changing the medication or the regimen.
- Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
- Avoid emotional stress.
- If interpersonal conflict is the cause, try relationship counseling.
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