Female sexual dysfunction

What is female sexual dysfunction?

It is estimated that up to 40 per cent of women have suffered from sexual problems in the past year. This might be caused by physical illness, but is often linked to psychological factors.

The female equivalent of impotence is known as female sexual arousal disorder (FSAD).

When men and women become sexually aroused, their genitals become engorged with blood. In women this normally results in:

• Enlargement of the clitoris and surrounding tissues (comparable to a male erection)
• Secretion of vaginal lubrication
• Relaxation and widening of the vaginal opening to permit intercourse

FSAD patients have the desire to have sex but their genital area fails to respond in the normal way, making sex painful or impossible.

Causes of female sexual dysfunction

FSAD can result from an underlying medical condition, such as high blood pressure or diabetes. It can also be caused by irritations, infections and growths in the vaginal area, or reactions to contraceptive devices. Medications used to treat high blood pressure, peptic ulcers, depression or anxiety and cancer may also cause problems.

Another factor is the physical, hormonal and emotional changes that occur during or after pregnancy, while breastfeeding or, very importantly, during and after the menopause.

FSAD is also often linked to psychological causes. These can include:

• Inadequate or ineffective foreplay
• Depression
• Poor self-esteem
• Sexual abuse
• Feelings of shame or guilt about sex
• Fear of pregnancy
• Stress and fatigue

Symptoms of female sexual dysfunction

The symptoms of sexual dysfunction can include lack of sexual desire, an inability to enjoy sex, insufficient vaginal lubrication or a failure to achieve an orgasm even if sexually aroused.

Women who suffer from female orgasmic disorder (FOD) are unable to achieve orgasm despite being sufficiently aroused to have sex.

Women differ from men in that orgasm is a learned, not automatic, response. About five to 10 per cent of women never have an orgasm through any type of sexual activity - a condition called anorgasmia. Anorgasmia is most often the result of sexual inexperience, performance anxiety or past experiences, such as sexual trauma or a strict upbringing, that have led to an inhibition of sexual response.

Some women are able to enjoy sexual activity in spite of reaching orgasm only some or even none of the time. FOD is a problem only if it has a negative effect on the satisfaction of a woman or her partner.

Treatments for female sexual dysfunction

Research has suggested the anti-impotence drug sildenafil citrate (Viagra) may help to treat sexual disorders in women by increasing blood flow to the sexual organs and thereby increasing physical stimulation in the area. However, the scientific community is still waiting for firm evidence to be published to show exactly how effective the drug is for women.

In 2009 a review of trials of Viagra for the treatment of FSAD found that the research showed that drug is moderately effective. It may also be effective in women with FSAD secondary to multiple sclerosis, diabetes or antidepressant use. However, more studies are needed to confirm these findings. A small study published recently found no positive impact on postmenopausal women.

Testosterone has been looked at as a treatment also but again, results have not been as positive as hoped. For the moment, doctors concentrate on eliminating medications that might have a negative effect on sexual performance. They also review contraceptive methods to ascertain whether this is a factor.

Women who suffer from vaginal dryness may also be recommended to use lubricants during intercourse. Some doctors recommend that women use Kegel exercises, which help to develop the muscles around the outer portion of the vagina that are involved in pleasurable sensations.

Psychological counselling can also play an important part in treating women with sexual problems, as can coaching in sexual foreplay and stimulation techniques.