Female sexual dysfunction includes persistent, recurrent problems with sexual desire, response, orgasm (satisfaction) or intercourse pain. Sexual dysfunction is a prevalent condition in women, and it occurs in about 40 percent of females in the world. This condition affects women of all ages, but most commonly found in menopausal women. Most of the women are hesitant to discuss the problems related to sex, which delays the treatment.
What is Female Sexual Dysfunction?
Sexual functioning is a complicated process, which involves both physical and psychological responses. Normal sexual function is an essential element of human life, both for the healthy reproductive process and also to lead a quality daily life. Many women have problems with sex at some or other situations in life, but, if these symptoms prolong for more than six months, then the patient has to consult a doctor for medical care.
Female sexual dysfunction is also classified as Sexual desire disorder, Sexual arousal disorder, Orgasm disorder and Sexual pain disorder.
Causes of Female Sexual Dysfunction:
Neurotransmitters play a vital role in the normal sexual function of a woman. A good physical and mental well-being of the patient impacts the release of neurotransmitters.
Some of the causes of sexual dysfunction are:
Hormonal imbalances, due to medical conditions like menopause, thyroid disorder, removal of the uterus, usage of oral contraceptives; affect female sex hormones like estrogen or progesterone.
Any gynecological issues like infection in the urinary tract, bladder or vagina or endometriosis (growth of uterine lining tissue outside the uterus on structures like ovaries).
Muscular problems like hyper or hypotonicity of pelvic floor muscles (muscles around the pelvic region) affect the secretions of female sexual organs.
Neurologic disorders, spinal cord injuries or peripheral nerve disorders affect the role of neurotransmitters, and this may further lead to sexual dysfunction.
Vascular disorders decrease the blood supply to female sex organs like the vagina or other structures of the reproductive system. This decrease in blood supply can be due to underlying chronic diseases like diabetes, chronic kidney disease or heart disease.
Psychological disorders like depression, relationship problems, mood fluctuations and lack of interest.
Lifestyle habits like smoking and drinking very frequently. These habits may lead to anger, confusion and isolation.
Symptoms of Female Sexual Dysfunction:
Symptoms of sexual dysfunction are complex. Women must have an explicit knowledge about the structures and functions of the female reproductive system. They should also discuss the problems clearly with the concerned doctor.
Some of the problems include:
- Lack of sexual desire
- Lack of orgasm (satisfaction) during intercourse
- Aversion to sexual activity
- Vaginal dryness
- Pain on intercourse
- Painful muscle spasms at the pelvis
Risk factors for Female Sexual Dysfunction:
Females in post-menopause phase are at higher risk for the development of sexual dysfunction. The risk factors include:
- Post hysterectomy
- Prolapsed pelvic organ
- Urinary incontinence
- Low estrogen levels
- Heart diseases
- Brain or spinal cord injury
- Drugs like painkillers or contraceptives
- Psychological depression
- Childhood sexual abuse
Complications of Female Sexual Dysfunction:
Female sexual dysfunction leads to many difficulties in the life of a woman. Few of the complications are listed here:
- Lack of interest in sex
- Strained relationships
- Social isolation
- Anger or irritability
- Physiological problems like vaginal or uterine diseases
Diagnosis of Female Sexual Dysfunction:
Detailed history from the patient is crucial to understand the causes of the disease and also to design a proper treatment plan. A questionnaire on the type of symptoms, the time of onset of symptoms and the patient’s knowledge about the female sex organs and their mechanism, may help in understanding the psychological state of the patient.
Pelvic examination is performed to understand the tone of the pelvic muscles, to evaluate the female genitalia and cysts in ovaries.
Pap smear test is a screening procedure to rule out any uterine complications like cervix cancer that may, in turn, lead to sexual dysfunction.
Transvaginal ultrasound is done to understand the structure of uterus, ovary and other parts of the female reproductive system.
Thyroid function test (T3, T4 and TSH) is performed, to understand if an altered thyroid level is a reason for hormonal imbalance and sexual dysfunction.
Treatment of Female Sexual Dysfunction:
Treatment of female sexual dysfunction completely depends upon the interest of the patient. The treating physician should have enough patience and also give enough time and freedom for the patient, to make her comfortable in discussing the symptoms in detail.
Counselling (behavioral therapy) and other techniques are used as the most common treatment for patients with sexual dysfunction.
The primary goal of this treatment is to relax the patient’s psychological state of mind and improve the intimacy with her partner.
Counselling plays a vital role. It includes education to the patient regarding sexual disorder and explains her ways to have an excellent sexual relation with her partner. A psychological counsellor may suggest few things as listed below-
- Maintaining a stress-free life
- Maintaining a peaceful environment for sexual activity
- Maintaining timely intercourse to improve the arousal for sex
- Maintaining a healthy diet plan
- Maintaining regular fitness of the body
- Restraining from smoking and excessive alcohol consumption
The counsellor should also give reassurance to the patient that, it is a common problem, and can be treated. Mostly, frank discussions with the partner will help to prevent the associated problems of the sexual dysfunction.
Physiotherapy also plays a role in solving the problem of weak pelvic floor muscles. Strengthening exercises for pelvic floor muscles (Kegel’s exercises) and deep breathing techniques also help in treating the dysfunction.
Drugs like antidepressants and anti-hypertensive are to be modified in dosage. This treatment is mainly done to avoid the side effects of these drugs on the sexual function of women.
Drugs like flibanserin or Addyiis used to treat female sexual dysfunction in postmenopausal women.
For women with hormonal imbalances as a cause for sexual dysfunction, hormonal therapy is prescribed. This therapy includes estrogen administration in the form of pills or as a topical ointment, to improve the vaginal activity and lubrication.
Lubricants or vibrators are also prescribed for improving vaginal lubrication and sexual arousal in women.
Inspite of the availability of drugs for the treatment of sexual dysfunction, they are rarely prescribed. The reason for medications not being used as a choice of treatment is, the adverse effects these drugs have on the patients overall health.
Surgery is a rare choice and is only done if the doctor is clear about the cause of the disease. The diagnostic test results are helpful, to have a clear view of the internal parts of the female genitalia.
Vestibulectomy is a surgical procedure in which the localized vulvar pain (localized vulvodynia) is treated by removing a small part of the vulvar tissue. This is mainly done in cases where, pain at the time of intercourse is the main cause of sexual dysfunction in the woman.
The scope of surgical treatment for patients with a sexual disorder is very less. So, it is also an unusual choice of therapy.
Prevention of Female Sexual Dysfunction:
Women can avoid sexual dysfunction by following few lifestyle modifications like practising yoga for stress relief; avoiding smoking; avoiding work pressure; averting regular sex patterns; preventing overuse of psychiatric medications; spendingquality time with the partner and self-understanding of the person’s sexual mechanism.
Female sexual dysfunction is a treatable disorder. Women should develop the courage to approach medical help in case of sexual problems and take timely treatment. Proper treatment can avoid any further complications and strained relationships due to sexual dysfunction.