Sexual Dysfunction in Women

Sexual dysfunction is anything that interferes with a woman's ability to function sexually. Sexual dysfunction may affect a woman's self-esteem and the relationship she has with her sexual partner.

The stress a woman experiences when her sexual relationship has problems is significant. The four major categories of sexual dysfunction include:

• Decreased desire for sex.
• Decreased arousal or ability of arousal by stimulation.
• Painful intercourse.
• Inability to achieve orgasm.

Many of these categories overlap. For instance, painful intercourse may lead to decreased sexual desire.

Diagnosing Sexual Dysfunction in Women

Many medical, social, marital, and emotional factors can affect a woman's sexual desire. For this reason, a detailed history is needed when discussing sexual problems. A good understanding of when the problem started and any other associated factors need consideration.

Usually sexual problems do not exist alone. Discussion of the current relationship and home situation are needed. The complexities and demands on a woman's day are many and understanding all of them leads to a better understanding of the underlying causes of sexual dysfunction. A detailed medical history is also necessary because of the many effects chronic diseases and medications have on sexual functioning.

Causes of Sexual Dysfunction in Women

Four major causes for sexual problems include medications, gynecologic conditions, hormone changes and marital and family relationships.

(a) Medications

Many common medications such as antidepressants, oral contraceptives, blood pressure medications and allergy medications could affect sexual desire and the ability to have an orgasm.

(b) Gynecologic Conditions

Certain gynecologic conditions also affect sexual functioning. Disorders of the bladder, urethra, and uterus can cause problems with intercourse. In addition, chronic vaginal infections can lead to painful intercourse. If left untreated many women are unable to have penetration of any kind in the future. Many women have had vaginal infections that resulted in painful intercourse. While cured of the infection, the pain remains.

(c) Hormone Changes

A leading cause of painful intercourse results from hormone changes caused by menopause or surgical removal of the ovaries. The changes in the vagina from a lack of estrogen can be dramatic in some women. The vagina and vulva become less elastic and causes pain during intercourse. The use of topical estrogens can make a huge difference in women suffering from this condition. Even breast cancer survivors use vaginal estrogens to maintain vaginal health because they are barely absorbed into the rest of the body. Menopause, whether natural or surgical, can also lead to decreased testosterone production. Half of a woman’s testosterone production comes from her ovaries. A decrease in testosterone can lead to changes in mood, sense of well being, sexual desire, and sexual responsiveness. Blood levels of testosterone are not always accurate or helpful. They can however, help guide the use of testosterone supplementation with pills, injections, or creams that can substantially affect a woman’s sexual desire and functioning. "Compounding" pharmacists usually make these supplements and medical insurance pays for many of them. Blood testosterone levels are monitored during supplementation for abnormal levels. Sometimes the physician will check cholesterol levels more frequently in patients using testosterone supplements. While patients have used over-the-counter supplements, the results are mixed. Over-the-counter testosterone supplements are not regulated and the concentration varies significantly from one brand to another.

(d) Marital and Family Relationships

Marital and family relationships may affect sexual functioning. Many problems result from poor communication and lack of understanding each partner's needs. Many couples think that not having an orgasm during intercourse is abnormal. In fact, many normal women do not achieve orgasm during intercourse, but are able to do so with other forms of stimulation. Without the understanding of what is normal, many couples feel anxiety and stress during sex. Actually, they may not have sexual dysfunction at all!

Depending on the cause for sexual dysfunction, some couples may need a referral to a marital or family counselor and others may need the expertise of a certified sexual therapist. The appropriate treatment can only be determined after a careful discussion of each individual situation.

Conclusion

Normal sexual functioning is as important as any other aspect of a woman's health. You should not hesitate to discuss it with your physician. Many problems are easily treatable and the positive effects on a woman's health and relationships can be significant.