Female Sexual Dysfunction
Donald Aulds, M.D.
The World Health Organization defines sexual dysfunction as the “various ways in which an individual is unable to participate in a sexual relationship as he or she would wish.” The following list includes the most common forms of sexual dysfunction in women as defined by the American Psychiatric Association:
- Hypoactive sexual desire disorder – the persistent or recurrent deficiency of sexual fantasies and desires which can cause distress or interpersonal problems. The desire may be present at the beginning of the relationship but may wane as the duration of the relationship continues. Most women sense desire once they are aroused but may not see desire prior to the arousal. The condition can start with such things as issues between the couple, lack of stimulation, psychological issues (such as negative experience and abuse in the past), partner sexual dysfunction, pain with intercourse, medications, premature loss of testosterone production and severe emotional stress.
- Female sexual arousal disorder – the persistent inability to attain or maintain an adequate lubrication-swelling response to sexual excitement. This very often leads to interpersonal stresses. The condition can be related to decreases in estrogen and/or testosterone, neurological conditions such as multiple sclerosis and Parkinson’s disease, and vascular conditions such as hypertension and diabetes. The condition can sometimes be related to depression, medication, distractions, expecting a negative outcome, poor stimulation and timing of sexual encounter.
- Female orgasmic disorder – the persistent or recurrent delay or absence of orgasm. The following list is a partial list of possible causes:
- Fear of losing control or being vulnerable
- Distractions – external or internal
- Medications – the following medications have been associated with decreased or lack of orgasm – SSRI medications (Prozac, Zoloft, Paxil, Effexor, Cymbalta, Celexa, Lexapro), alcohol, sedatives, pain medications (especially with long term use of oxycodone and hydrocodone)
- Neurological disorders – multiple sclerosis, nerve damage from pelvic injuries and nerve compression
- Decreased testosterone
- Trust and control issues – usually due to stress in the relationship
- Dyspareunia – the persistent or recurrent pain with sexual intercourse. This is associated with decreased estrogen, infections, recurrent urethritis, endometriosis, fixed tilting of the uterus, prolonged intercourse, interstitial cystitis, vaginal tears, and congenital vulvar or vaginal anomalies.
- Vaginismus – recurrent or persistent spasms of the muscles of the vagina. The contractions of the muscles usually occur in the lower third of the vagina usually on the attempt to enter the vagina. This dysfunction generally has a psychological basis and requires an evaluation.
The evaluation of female sexual disorder includes a physical exam; lab work that may test estrogen, testosterone, prolactin, thyroid and cortisol levels; review of current medications; review of partner’s sexual response and possible dysfunction; and review of medical conditions. Seek medical attention if you feel that any of these problems are present.