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.
t 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 women are affected by sexual dysfunction to some degree, and approximately 1 in 4 women are unable to achieve orgasm.
According to the Sexual Advice Association, sexual problems affect around 50% of women and become more common as women get older.
Dysfunction can include loss of desire, loss of arousal, problems with orgasm, and pain during sex.
To identify the reasons behind sexual dysfunction, both physical and psychological factors have to be considered, including a woman’s relationship with her partner.
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 and Complications of Female Sexual Dysfunction
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
- 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.
Loss of desire
Loss of desire, or lack of sex drive, affects some women at certain times of life, such as during pregnancy or times of stress. But some women experience it all the time.
A lack of sex drive can have a range of physical or psychological causes, including diabetes, depression, relationship problems, hormone disorders, excessive alcohol and drug use, tiredness, and previous traumatic sexual experience.
Sex drive can also fall if a woman’s natural testosterone levels drop. Testosterone is produced in the ovaries and adrenal glands, so levels can drop if these are removed or if they’re not functioning properly.
These can be divided into two types: primary (when a woman has never had an orgasm) and secondary (when a woman has had an orgasm in the past but can’t now).
Some women don’t need to have an orgasm to enjoy sex, but an inability to reach orgasm can be a problem for some women and their partners.
Reasons why a woman can’t have an orgasm can include fear or lack of knowledge about sex, being unable to “let go”, not enough effective stimulation, relationship problems, mood disorders (such as depression), and previous traumatic sexual experience.
Research is being done into certain medical conditions that affect the blood and nerve supply to the clitoris to see whether this affects orgasm.
Psychosexual therapy can help a woman overcome orgasm problems. It involves exploring her feelings about sex, her relationship and herself.
Pain during sex (also called dyspareunia) is common after the menopause as oestrogen levels fall and the vagina feels dry. This can affect a woman’s desire for sex, but there are creams that can help. Ask your GP or pharmacist.
Vaginismus is when muscles in or around the vagina go into spasm, making sexual intercourse painful or impossible. It can be very upsetting and distressing.
Vaginismus can occur if the woman associates sex with pain or being “wrong”, if she’s had vaginal trauma (such as childbirth or an episiotomy), relationship problems, fear of pregnancy, or painful conditions of the vagina and the surrounding area.
It can often be successfully treated by focusing on sex education, counselling and the use of vaginal trainers. Vaginal trainers are cylindrical shapes that are inserted into the vagina.
A woman will gradually use larger sizes until the largest size can be inserted comfortably.
To establish the cause of sexual dysfunction, a doctor or therapist will need to ask you questions about your medical, sexual and social history. Your GP can carry out tests for underlying medical conditions.
If your problem is related to lack of hormones such as testosterone or oestrogen, hormone replacement therapy (HRT) can help.
Treating other conditions such as diabetes or depression might also alleviate symptoms of sexual dysfunction.
In many cases, sexual therapy can help. Talk with your partner about your problem and see a therapist together if you can. Don’t be embarrassed.
Many people experience sexual dysfunction and there are ways to get help.
Your GP can refer you to a therapist, or you can see one privately.
Treating and Preventing 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.