Female Sexual Dysfunction

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Introduction

Historically, female sexual difficulties were believed to be psychological.  Today, physicians realize that the female sexual response is a complex process that can involve many factors, including psychological and physical components.  It is common for most women to experience sexual problems at some point in their life.  Although the cause of female sexual dysfunction is multifaceted, it is usually treatable.  It is important to understand your anatomy and sexual response, communicate openly with your partner, and consult health care professionals that you are comfortable with to help regain sexual satisfaction.
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Anatomy

The female reproductive system consists of internal organs and external genitalia.  The internal female reproductive system includes the ovaries, fallopian tubes, uterus, cervix, and vagina.  The ovaries are two small organs that produce eggs (ova) and hormones.  When a baby girl is born, her ovaries contain all of her eggs.  At puberty, hormones signal a girl’s sexual reproductive system to develop, after which time an ovary typically releases one mature egg each month.  Two fallopian tubes extend from near the ovaries to the uterus.  The fallopian tubes transport the mature eggs to the uterus (womb).
 
The uterus is a pear-shaped organ where a baby grows in during pregnancy.  The lining of the uterus undergoes cyclic changes to facilitate and maintain pregnancy.  If a pregnancy does not occur, the uterine lining is shed each month during menstruation.
 
The cervix is an opening that joins the uterus to the vagina.  The vagina is a muscular passageway that extends from the cervix to the outside of the body.  The vagina has several functions.  Menstrual blood leaves the uterus and travels through the vagina during a female’s period.  A baby moves from the uterus and through the vagina during childbirth.  The male’s penis is inserted into the vagina during sexual intercourse, at which time sperm may travel from the vagina, through the cervix and enter the uterus and fallopian tubes to fertilize an egg.
 
The external female genitalia are referred to as the vulva or pudendum.  The mons pubis and outer labia major are covered with hair in the mature female.  The labia major and labia minor are two pairs of skin flaps that surround the vaginal and urethra openings.  The urethra opening is located in front of the vaginal opening in the vestibule.  The urethra carries urine from the bladder to outside of the body.  The clitoris is located where the front folds of the labia join.  The clitoris is a small sensory organ that responds to sexual stimulation.
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Causes

Female sexual dysfunction is common and usually treatable.  Female sexual dysfunction can result from several overlapping factors including intimacy, relationship, physical, medical, psychological, emotional, experience, belief, and lifestyle issues.  Any factor or a combination of factors can affect sexual desire, arousal, and satisfaction.  Some physical factors may cause pain during sexual contact.  Female sexual dysfunction is defined as experiencing one or more sexual problems and personal distress because of it or it negatively affects the relationship with your partner.
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Symptoms

Symptoms of female sexual dysfunction may include low sexual desire, sexual arousal disorder, orgasmic disorder, and sexual pain disorder.  Your symptoms may overlap or change over time.  Low sexual desire or lack of a sex drive is the most common symptom among women.  Interest in sex, but the inability to become or maintain aroused is termed sexual arousal disorder.  Orgasmic disorder refers to inability or difficulty achieving orgasm after sufficient stimulation and arousal.  You may experience pain during sex, such as clitoris pain during stimulation or vaginal pain during sexual intercourse.
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Diagnosis

You should discuss your sexual concerns with a doctor that you feel comfortable with.  It may be your regular physician, gynecologist, or psychiatrist.  Your doctor may refer you to other specialists that can help you.

You should receive a physical and pelvic examination from a medical doctor.  Your doctor will review your medical history, medications, and may conduct tests, such as hormonal testing.  Your doctor may refer you to a specialized counselor or sex therapist, depending on your issues.
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Treatment

Treatment varies, depending on the reasons for your sexual dysfunction.  It may help to discuss emotional or relationship issues with your partner and a qualified therapist or counselor.  Open communication with your partner, including your likes and dislikes during sexual interaction may also help.  Your doctor may recommend books or resources to help you communicate your feelings.

Lifestyle changes may help improve your sex life.  Avoiding alcohol, illegal drugs, and cigarettes and healthy eating and regular exercise may help.  Participating in relaxing activities and taking time for yourself amid a busy day can help.  Create an environment that is romantic and comfortable for you and your partner.  It may help to plan sexual activity at a place or time that is free of distractions or interruptions.

Counseling may help to resolve issues of physical, emotional, or sexual abuse.  A therapist can help you examine and resolve your beliefs and attitudes about sex.  Sex therapy may include education and suggestions for enhancing intimacy with your partner.

Medical treatment for female sexual dysfunction includes addressing physical or psychological problems.  In many cases, medications or a change in existing medication may help to treat underlying conditions.  Some women may benefit from hormone medications or surgery.  Your doctor can educate you about preventing pregnancy and sexually transmitted diseases.
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Am I at Risk

Several interrelated factors may contribute to sexual dysfunction or dissatisfaction including:


_____ Sexual difficulties may increase during times of hormonal change, such as during pregnancy, after giving birth, while breast feeding, or during menopause. 
_____ Hormonal changes during menopause may cause your genital tissues to change and your vagina to become narrower and dryer.  This may lead to inadequate lubrication and slower arousal.
_____ Your sexual response may change if you are experiencing a serious illness, such as cancer. 
_____ Physical conditions, including arthritis, urinary or bowel problems, fatigue, headache, or neurological disorder, can lead to sexual problems.
_____ Certain medications, such as antidepressants, high blood pressure medication, antihistamines, and chemotherapy, can decrease your sex drive and reduce your ability to achieve orgasm.
_____ Conflict with your partner, stress at home or work, over-scheduling, or parenting issues are examples of social factors that can contribute to sexual problems.
_____ Untreated anxiety, depression, or other psychiatric disorders can contribute to sexual dysfunction.
_____ Women with a history of domestic violence, abuse, sexual assault, or rape may experience sexual difficulties.
_____ Cultural or religious issues may contribute to sexual problems.
_____ Many factors about your sexual partner can contribute to your sexual satisfaction, including the quality of your relationship, communication, emotional expression, emotional affection, and sexual performance.
_____ Your self-image or feelings about your physical appearance or weight may contribute to your sexuality.
_____ Distraction in your environment may interfere with your ability to respond sexually.  Examples of distractions include the TV, crying or noisy children, traffic noise, etc.
_____ Infection or sexually transmitted disease may cause discomfort or irritation during sexual contact.
_____ Feelings of fear or shame about sex may contribute to sexual dysfunction.
_____ Fear of pregnancy, pain, or infection may contribute to sexual dysfunction.
_____ Too much alcohol, substance abuse, cigarette smoking, and lack of exercise can affect your sexual health, as well as overall health.

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Complications

It is important to realize that there are real and complex reasons for female sexual dysfunction and that it is normally treatable.  Finding the answers to your problems can help boost your self-esteem, sexual satisfaction, and relationship.  In some cases, difficulties that are not addressed may lead to poor self-esteem, depression, anxiety, and relationship problems.
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Advancements

Researchers are studying medications to heighten the female sexual response, including the effectiveness of medications that are presently being used for men, such as Viagra or Cialis. 
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.