Female Sexual DysfunctionEn Español (Spanish Version)
Female sexual dysfunction refers to recurrent problems during any phase of the sexual response cycle (excitement, plateau, orgasm, resolution) that causes distress or negatively affects your relationship with your partner.
The following factors tend to be interconnected:
Conditions that may cause problems with sexual function include diabetes, heart disease, cancer, neurological disorders (depression, anxiety, history of sexual abuse), arthritis, fatigue, headaches, urinary or bowel difficulties, alcoholism, and drug abuse. The side effects of certain medications, including antidepressant drugs, blood pressure medications, and chemotherapy drugs, can affect sex drive and functioning.
During menopause in particular, estrogen levels decrease, which can cause changes to occur in your genital tissues and your sexual responsiveness. Intercourse may become painful (dyspareunia), and/or it may take longer for you to achieve an orgasm.
Untreated emotional and psychological issues need to be addressed for treatment to be effective. Factors that affect sexual functioning may include anxiety, depression, stress, sexual abuse in the past, self-perception during and after pregnancy, and conflict with you partner.
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Defining sexual dysfunction as such is largely dependent upon your own perception of sexual difficulties and your relationship with your partner.
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include medical conditions or diseases, hormonal changes, side effects of medications, and psychological and social conditions.
Symptoms of sexual dysfunction include experiencing personal distress because of one or more of the following:
- Low sexual desire—You have a lack of interest in sex and experience poor libido.
- Inability to become aroused—Although your desire to have sex may exist, you are unable to become physically aroused or to maintain arousal during sex. This may be due to insufficient vaginal lubrication, anxiety, or lack of clitoral/vaginal sensation.
- Orgasmic disorder—You consistently have difficulty achieving sexual climax, or are unable to do so.
- Pain during intercourse—You experience pain during sexual stimulation and/or penetration. Vaginismus is an involuntary, painful vaginal contraction that inhibits penetration.
Your doctor will ask about your symptoms, medical history, sexual history, and the medications you take. Your doctor will also conduct a gynecologic exam.
The diagnostic process may include:
- Swabs of vaginal fluid to evaluate for infection or bacterial imbalance
- Cervical swabs to test for sexually transmitted diseases (STDs)
- Urine tests
- A pelvic exam to check for signs of physical changes, including thinning of genital tissues, decreased skin elasticity, and scarring
- A psychological evaluation of possible contributing factors, such as anxiety, depression, past sexual abuse, and relationship problems
Because of the multifactorial nature of the disorder, both medical and nonmedical treatments may be recommended.
Medical treatments address the underlying conditions, and include the following:
- Changing medication that may have sexual side effects
- Treating depression and anxiety
- Using vaginal lubricants to relieve dyspareunia, vaginal dryness, and irritation
Possible hormone therapies—These include estrogen replacement therapy (ERT) and androgen therapy.
- Estrogen supplementation, such as the low-dose estradiol skin patch,*¹ can help with vaginal pain and dryness.
- Androgen therapy includes the controversial use of testosterone treatment for sex drive/libido. The treatment is not approved by the US Food and Drug Administration (FDA) at this time and is only to be used under medical supervision.
Nonmedical treatments improve sexual health and decreased desire. These include:
- Working with a sex therapist
- Making lifestyle changes to improve your overall health (for example, diet and exercise)
- Strengthening your pelvic muscles by doing Kegel exercises
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.
- Avoid emotional stress.
- If interpersonal conflict is the cause, try relationship counseling.
American Academy of Family Physicians
American College of Obstetricians and Gynecologists
Cleveland Clinic Foundation
Mayo Foundation for Medical Education and Research
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada
Berman JR, Adhikari SP, Goldstein I. Anatomy and physiology of female sexual function and dysfunction. European Urology. 2000;38:20-29.
Berman JR, Berman L, Goldstein I. Female sexual dysfunction: incidence, pathophysiology, evaluation, and treatment options. Urology. 1999;54(3):385-391.
Cleveland Clinic Foundation website. Available at: http://www.clevelandclinic.org/health..
Dr. Laura Berman website. Available at: http://www.drlauraberman.com/PublicSite/Index.aspx and http://www.bermancenter.com/..
Mayo Foundation for Medical Education and Research website. Available at: http://www.mayoclinic.com/health..
The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.com/pubs/mmanual/section18/chapter243/243a.htm. Accessed October 13, 2005.
Phillips NA. Female sexual dysfunction: evaluation and treatment. Am Fam Physician . 2000 Jul 1;62(1). Available at: http://www.aafp.org/afp/20000701/127.html..
*¹9/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Huang A, Yaffe K, Vittinghoff E, et al. The effect of ultralow-dose transdermal estradiol on sexual function in postmenopausal women. Am J Obstet Gynecol. 2008;198:265.e1-7.
Last reviewed May 2008 by Ganson Purcell Jr., MD, FACOG, FACPE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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