Definition

Female sexual dysfunction refers to recurrent problems during any phase of the sexual response cycle (excitement, plateau, orgasm, resolution) that causes distress or negatively affects your relationship with your partner.

Causes

The following factors tend to be related:

Risk Factors

This condition is most common in those aged 45-64.

Factors that may increase your risk of sexual dysfunction include:

• Medical conditions or diseases
• Hormonal changes
• Certain medications
• Psychological and social conditions

Symptoms

Symptoms of sexual dysfunction include experiencing personal distress because of one or more of the following:

• Low sexual desire—You have a lack of interest in sex and have poor libido.
• Inability to become aroused—Although your desire to have sex may exist, you are unable to become physically aroused or to maintain arousal during sex. This may be due to insufficient vaginal lubrication, anxiety, or lack of clitoral/vaginal sensation.
• Orgasmic disorder—You consistently have difficulty achieving sexual climax, or are unable to do so.
• Pain during intercourse—You experience pain during sexual stimulation and/or penetration. Vaginismus is an involuntary, painful vaginal contraction that inhibits penetration.

Diagnosis

Defining sexual dysfunction is largely dependent on your own view of sexual difficulties and your relationship with your partner.

You will be asked about your symptoms, medical history, sexual history, and the medications you take. A gynecologic exam will be done. You may also have a psychological evaluation.

Your bodily fluids may be tested. This can be done using:

• Swabs of vaginal fluid
• Cervical swabs
• Urine tests

Treatment

Because many factors can lead to the disorder, both medical and nonmedical treatments may be recommended.

Medical treatments address the underlying conditions, and include the following:

• Changing medication that may have sexual side effects
• Treating depression and anxiety
• Using vaginal lubricants to relieve dyspareunia, vaginal dryness, and irritation
• Hormone therapies:
  • Estrogen supplementation, such as the low-dose estradiol skin patch or topical estrogen, can help with vaginal pain and dryness.
  • Androgen therapy includes the controversial use of testosterone treatment for sex drive/libido. The treatment is not approved by the United States Food and Drug Administration (FDA) at this time and is only to be used under medical supervision.

Other treatments to improve sexual health and decreased desire include:

• Working with a sex therapist
• Making lifestyle changes to improve your overall health through things like diet and exercise
• Strengthening your pelvic muscles by doing Kegel exercises

Prevention

You can’t avoid all the risk factors for female sexual dysfunction. However, avoiding emotional stress may help.

Family Doctor—American Academy of Family Physicians http://www.familydoctor.org

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

Berman JR, Adhikari SP, Goldstein I. Anatomy and physiology of female sexual function and dysfunction. European Urology. 2000;38:20-29.

Berman JR, Berman L, Goldstein I. Female sexual dysfunction: incidence, pathophysiology, evaluation, and treatment options. Urology. 1999;54(3):385-391.

Dennerstein L. How changing methods affect our understanding of female sexual function and dysfunction J Sex Med. 2010;7(7):299-300.

Female sexual dysfunction. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated August 12, 2013. Accessed October 29, 2014.

Phillips NA. Female sexual dysfunction: evaluation and treatment. Am Fam Physician. 2000;62(1).

9/16/2008 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Huang A, Yaffe K, Vittinghoff E, et al. The effect of ultralow-dose transdermal estradiol on sexual function in postmenopausal women. Am J Obstet Gynecol. 2008;198:265.e1-7.

2/17/2009 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112:970-978.