£Female sexual dysfunction (FSD) is a disorder characterized by a persistent or recurrent inability to attain sexual arousal or to maintain arousal until the completion of a sexual activity.
The diagnosis can also refer to an inadequate lubrication-swelling response normally present during arousal and sexual activity. The condition should be distinguished from a general loss of interest in sexual activity and from other sexual arousal disorder, such as the orgasmic disorder (anorgasmia) and hypoactive sexual desire disorder, which is characterized as a lack or absence of sexual fantasies and desire for sexual activity for some period of time.
Although female sexual dysfunction is currently a contested diagnostic, it has become more common in recent years to use testosterone-based drugs off-label to treat FSD. While drug companies are technically not allowed to market these drugs for off-label uses, sharing the information with doctors at CME conferences has proved to be an effective way to navigate around the FDA approval process.
Causes of Female Sexual Dysfunction
Female sexual dysfunction may be related to physical factors, psychological factors, or a mixture of both: It can also be a matter of problems with technique: some women never fully experience sexual arousal and orgasm because they or their partners lack sexual knowledge. They may not understand how female sex organs respond or are stimulated, or don’t use appropriate arousal techniques.
At the same time, sexual dysfunction has a strong interpersonal component: A person’s view of their own sexuality is largely influenced by culture, society, and personal experience. It may be intimately connected to their own or society’s ideas about the appropriate or inappropriate expression of sexual behaviour. These feelings may cause anxiety because of a personal or cultural association of sexual experience and pleasure with immorality and bad behaviour. Anxiety is then expressed physically by the body in a way that prevents normal sexual function. Anxiety can do this, for example, by stopping or slowing the state of sexual excitement that allows for the lubrication or moistening of the female genitalia – an important step towards fulfilling forms of sexual activity.
Personal character, disposition, and life experience play a role in sexual dysfunction: Fear of intimacy can be a factor in arousal problems. Experiences of abuse, either in childhood or in past or current relationships, can establish a cycle of associating sex with psychological or physical pain. Attempting sexual activity in these circumstances causes more psychological or physical pain. For example, if anxiety prevents lubrication, sexual intercourse can be painful.
Conflict, tension, and incompatibility with a sexual partner can cause sexual dysfunction: Depression may be a cause, and stress a contributing factor. Medications, including oral contraceptives, antihypertensives, antidepressants, and tranquilizers are very common causes of sexual dysfunction. Also, the use of oral contraceptives can decrease a woman’s interest in sex. If you’re taking any of these medications, talk to your doctor about its possible contribution to sexual problems.
Physical causes include disorders of the genitalia and the urinary system, such as endometriosis, cystitis, vaginal dryness, or vaginitis: Other conditions such as hypothyroidism, diabetes, multiple sclerosis, or muscular dystrophy can have an impact on sexual desire and ability. Surgical removal of the uterus or of a breast may contribute psychologically to sexual dysfunction if a woman feels her self-image has been damaged.
Certain prescription and over-the-counter medications as well as the use of illegal drugs or abuse of alcohol may contribute to sexual dysfunction. Cigarette smoking may have a negative effect on sexual arousal in women.
Although women can remain sexually active and experience orgasms throughout their lives, sexual activity often decreases after age 60. While part of this may be due to a lack of partners, changes such as dryness of the vagina caused by lack of estrogen after menopause may make intercourse painful and reduce desire. After menopause, about 15% of women feel a strong decrease in sexual desire.
Symptoms of Female Sexual Dysfunction
Your symptoms will depend on the type or types of female sexual dysfunction you have:
- Low sexual desire: This most common of female sexual dysfunctions involves a lack of sexual interest and willingness to be sexual.
- Sexual arousal disorder: Your desire for sex might be intact, but you have difficulty with arousal 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.
- Feelings of fear or anger towards their partners
Medical Treatment of Female Sexual Dysfunction
The first step in managing female sexual dysfunction is to see a health care provider for assessment and appropriate treatment.
Physical disorders should be treated. For sexual dysfunction associated with aging and dryness of the vagina, vaginal moisturizers or estrogen treatment (such as a vaginal cream, vaginal ring, or low-dose tablet taken by mouth) can be effective.
When psychological factors are foremost, counselling from a psychiatrist, psychologist, or sex therapist may help to remove or reduce the causes. Psychotherapy may be more useful if there has been some trauma in a woman’s background, or problems that stem from stress or relationships. Therapy that includes a sexual partner is more helpful in increasing the chance of learning to experience orgasm.
To both treat and prevent sexual dysfunction, women should understand how their sex organs work and how they can respond. The vagina is like a muscle, and with inactivity, it becomes harder to use. Activities like masturbation and Kegel exercises can increase blood flow to the vaginal area, making sex more comfortable. Kegel exercises can make pelvic floor muscles stronger and help women reach orgasm more easily. This is a technique that women of every age can use to enhance sexual pleasure.
To do Kegel exercises, tighten your pelvic floor muscles (these are the same muscles you use to stop the flow of urine when you’re going to the bathroom) for 3 seconds, relax for 3 seconds, and repeat 10 times. Gradually increase the time until you are tightening the muscles for 10 seconds and relaxing for 10 seconds.
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