Female Sexual Dysfunction

(Low Libido in Women, Decreased Sex Drive - Female, Sexual Dissatisfaction in Women, Lack of Sexual Desire in Women)

In this condition factsheet:

• The Facts
• Causes
• Symptoms and Complications
• Making the Diagnosis
• Treatment and Prevention

The Facts

Female sexual dysfunction occurs when a woman is not able to fully, healthily, and pleasurably experience some or all of the various physical stages the body normally experiences during sexual activity. These stages can be broadly thought of as the desire phase, the arousal phase, and the orgasm phase. Sexual dysfunction also includes painful intercourse.

In women, sexual dysfunction takes many forms and has numerous causes. It is important to address all the aspects of a woman's sexuality – whether physical, psychological, physiological (mechanical), or interpersonal – in order to resolve the problems.

Female sexual dysfunction is actually quite common. It has been estimated that about 40% of sexually active women are affected by sexual dysfunction to some degree, and approximately 5% of women are unable to achieve orgasm.

Causes

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 or anxiety may be a cause, and stress a contributing factor. Medications, including antihypertensives, antidepressants, and tranquilizers are very common causes of sexual dysfunction. 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.

The majority of cases involve causes from multiple categories. Additionally, 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 and obesity 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, women also have a noticeable decline in sexual interest.

Symptoms and Complications

Women who do not enjoy satisfying sexual experiences with their partners often report the following:

• lack of sexual desire (low libido)
• inability to attain an orgasm
• reduction in the intensity of orgasm
• pain or other distress during penile penetration
• an inability to fantasize about sexual situations
• indifference to, or repulsion by, having sex
• feelings of fear or anger towards their partners

Most often, any of these responses have psychological complications. Whether the symptoms are due to physical factors, such as menopause, or have their origins in more deep-seated psychological triggers, many women are likely to feel inadequate or dysfunctional. They blame themselves for not being sexually responsive, have trouble explaining to their partners about how they feel, and experience low self-esteem as a result.

Making the Diagnosis

Typically, a doctor diagnoses a sexual disorder if a women experiences symptoms for at least 6 months and is under significant distress. Establishing the cause of sexual dysfunction is half the battle. The stage of sexual activity at which a woman is having problems may offer some clues. Other evidence may be found through physical and psychological testing. Your family doctor can refer you to specialists who can help pinpoint what's causing the problem.

In sexual interest/arousal disorder, a woman experiences a decreased interest in having sex. There are several subtypes of sexual interest/arousal disorder based on the types of arousal symptoms that are missing – genital, subjective, or combined. In genital arousal disorder, sexual arousal occurs in the mind but without genital symptoms such as genital lubrication, swelling, or warmth. In contrast, subjective arousal disorder occurs when there are genital symptoms related to sexual arousal but without sexual pleasure.

With genito-pelvic pain/penetration disorder, women experience pain and tightening during attempted penetration. Often, there are other medical conditions involved such as vaginal infections, menopause, or abnormal growths in the pelvis. In some cases, this disorder can be caused by fear and anxiety based on previous experiences with painful intercourse.  

Orgasmic disorder means that a woman may enjoy sexual activity but has difficulty reaching orgasm or takes a very long time to reach orgasm. Physical causes are rare, except in cases of nerve damage in the spine. Psychological factors may range from never having learned how to have an orgasm, to unrealistic expectations from a partner, to feelings of guilt at experiencing pleasure. Orgasmic disorder is diagnosed only when a woman has no difficulty with arousal, only with climax.

To rule out a sexually transmitted infection, which can contribute to sexual dysfunction, doctors may take a sample of fluids from the vagina and send it to a laboratory for further evaluation.

Treatment and Prevention

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 lubricants, moisturizers or estrogen treatment (such as a vaginal cream, vaginal ring, or low-dose tablet taken by mouth) can be effective. Testosterone may be used in certain cases of sexual interest/arousal disorder. If possible, medications thought to be causing sexual dysfunction should be switched to another.

The medication flibanserin* can be used in premenopausal women who experience low sexual desire and find it distressing. This medication needs to be taken on a daily basis, and it can cause some serious side effects, especially if alcohol is taken close in time (e.g., within 2 hours).

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.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.

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