Female Sexual Dysfunctions
Frederick R. Jelovsek MD
Over 40% of women may have a sexual problem at sometime in their lives. While it is natural to look for medical diseases or hormonal deficiencies as the sole cause, most sexual dysfunction is a combination of both physiological and psychological factors. In a recent continuing medical education article, Petok WD: A practical approach to evaluating female sexual dysfunction. OBG Management 1999;11:68-77, outline the six most commonly seen female sexual dysfunctions.
Common Female Sexual Dysfunctions
What are the most commonly seen sexual problems that women have?
Petok lists six commonly seen sexual problems that present to doctors and sex therapists. They are:
- Hypoactive sexual desire disorder (HSDD) - lack of sexual desire with a sort of passive apathy, not seeking out sex but not actively resisting when a partner initiates sex.
- Sexual aversion disorder (SAD) - an active aversion to all genital sexual contact which may manifest itself as revulsion, fear or anger.
- Female sexual arousal disorder (FSAD) - rare, if ever, thoughts about sex or getting "turned on" except in perhaps a theoretical way. Lay persons would term this frigidity.
- Female orgasmic disorder (FOD) - lack of orgasm with sexual intercourse or stimulation.
- Dyspareunia - vulvar, vaginal or even pelvic pain with intercourse.
- Vaginismus - recurrent or persistent involuntary spasm of the perineal or levator muscles that prevents vaginal penetration of any kind including vaginal exams.
What would be some of the reasons for decreased sexual desire?
Certain factors may be associated with this: illnesses, medication side effects, depression, alcohol or drug abuse, spousal abuse, active extra marital affairs, and severe marital distress in which divorce or separation is imminent. If the low desire is specific to a partner, it may be due to being bored with the same sexual script, differential desire levels in the couple, or aversion to one's partner.
If there is a degree of anger with one's partner, This may be sexual aversion disorder. That is a more active lack of sexual desire evident in women who may be having pain with sexual relations, a history of rape or sexual abuse, or just plan anger at one's spouse.
How does not getting sexually aroused differ from decreased desire?
Women who have decreased sexual desire can get aroused and lubricated and go through the normal phases of excitement, plateau, orgasm and resolution; while women with arousal disorder do not even have sexy thoughts. They have a hard time focusing on fantasies or sexual cues from partners. They cannot maintain adequate vaginal lubrication and seldom report sexual excitement, pleasure and romance that other women report. The male equivalent of this problem is impotence, or failure to get an erection.
What would be causes for lack of orgasm?
Women do not always have orgasms and if they note lack of simultaneous orgasm or do not have as frequent orgasm as "reported in Cosmo", that does not connote female orgasmic disorder. It is important to note if orgasm can be produced through masturbation and if a woman enjoys sex and feels good about herself, her partner and their relationship. Some women have a fear of losing control, fainting or even "appearing foolish to a partner while lost in the throes of orgasm."
How does pain with sexual relations get treated?
There is often a medical cause for pain with sexual relations. There may be chronic vaginal infections, decreased lubrication from menopause, estrogen deficiency and the postpartum physiological state or nursing. Many pelvic problems such as uterine prolapse, endometriosis, pelvic tumors and other anatomical problems can produce a deeper pelvic pain with sexual relations. Treatments are directed at the cause for the pelvic pain.
Sometimes, however, when there are no anatomical causes for the pain with sexual relations, therapists find psychological factors such as guilt or shame about sex, religious beliefs that arouse shame or guilt, poor body image and even complaints that partners do not provide enough foreplay for them to be adequately aroused.
If a woman cannot even tolerate a pelvic exam, is there any hope for having sexual relations eventually?
Vaginismus is well known to gynecologists in women who cannot even allow a speculum or a finger to be introduced into the vaginal opening. They get an involuntary spasm of the levator and perineal muscles that they cannot control. This same reaction prevents any vaginal intercourse. It may represent a conditioned response to the fear of pain with sexual relations or even just thoughts about intercourse.
Treatment usually involves graduated dilators that are used to slowly stretch the vaginal canal and allow a woman to have a greater sense of self-control. It is a form of desensitization therapy and can have a good success rate to restore the ability to have vaginal intercourse and a successful sexual relationship.
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