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Female Sexual Dysfunction: Symptoms, Risk Factors, and Treatment Options

Sexual dysfunction in women is common and covers a wide variety of problems, including painful sex, vaginal dryness, low libido, and difficulty having an orgasm. If you think your sex life is suffering, or if some of these conditions apply to you, read on for the answers to common questions about female sexual dysfunction.

Sexual dysfunction refers to a cluster of different problems with sex, from painful intercourse to decreased sex drive, and trouble achieving orgasm. About 40 percent of women are affected by sexual dysfunction in some form or another, so there’s nothing unusual or shameful about problems you may be experiencing. Many women experience problems with sexual function at some point, and some have difficulties throughout their lives. There are many medical conditions that come with sexual dysfunction symptoms, so the problem may have nothing to do with how you feel about your partner.

Female sexual dysfunction (FSD) becomes more common as women age, especially once they go through menopause. The peak age group for FSD is 51–59 years old, around the time of menopause. According to the Sexual Advice Association, sexual problems affect around 1 out of 3 young and middle-aged women and around 1 out of 2 older women. Although sexual dysfunction in men, especially erectile dysfunction, has been extensively studied and there are several medications for males, there is no female sexual dysfunction pill. Many treatments for FSD include treating an underlying medical condition and therapy.

FSD falls into several different types, and treatment varies. Sometimes, sexual trauma in the past results in physical symptoms that make sexual intercourse painful or produce effects that mimic another medical condition. Other causes can include the following.

When intercourse hurts, it can be difficult to get excited about sex, even if you desire your partner. Vulvodynia is when someone has chronic pain around the opening of the vagina and clitoris. Dyspareunia is general pain during intercourse and can happen from trauma to the pelvis, personal trauma, childbirth, endometriosis, pelvic inflammatory disease, large fibroids or ovarian cysts, and pelvic surgery. A skin condition called Lichen sclerosus, which causes white patches of skin around the genitals, can make the labia itchy and sex painful. There is also a medical condition called vaginismus, which is when the muscles of the vagina spasm when something like a tampon or penis enters it. People who have gone through menopause may experience problems with lubrication in the vagina due to low estrogen levels, also leading to painful intercourse.

Low libido or decreased sex drive can stem from hormonal changes during menopause (low estrogen levels), hormonal changes at a younger age (ovarian insufficiency, thyroid dysfunction or elevated prolactin levels), or from certain kinds of hormonal birth control. Some people report having reduced desire during pregnancy or due to postpartum depression. Other times, a lack of sex drive can stem from personal trauma or indicate underlying issues in your relationship.

Female orgasmic disorder is when a woman has a persistent or recurrent problem achieving orgasm after sufficient sexual arousal and stimulation. In this case, the doctor will want to know if you’ve been able to orgasm before or have always had this problem.

Low sexual desire is the most common symptom of FSD. It includes a lack of interest in sex or unwillingness to be sexual. A sexual arousal disorder, on the other hand, refers to being unable to become aroused during foreplay or sex or being unable to maintain arousal even if your desire for sex is there.

Symptoms of orgasmic disorders include consistent difficulty or inability to achieve orgasm even after ongoing stimulation and arousal. Sexual pain disorders include conditions that cause pain during sexual contact or inside and around the vagina. This doesn’t necessarily have to be just from penis-in-vagina stimulation but can be triggered by using tampons or riding a bike.

A specific condition called genitourinary syndrome of menopause (GSM) covers female sexual dysfunction symptoms linked to menopause and hormonal changes. Burning or itching in and around the vagina, dryness or discomfort during intercourse, and urinary problems are some of the symptoms. Others include a lack of desire and inability to maintain arousal. In the case of GSM, hormonal treatments may be beneficial.

There are many different causes of FSD. Sexual response involves a complex interplay of physiology, emotions, experiences, beliefs, lifestyle, and relationships. Disruption of any component can affect sexual desire, arousal, or satisfaction.

Fluctuating estrogen and progesterone levels in your body can also cause a hormonally based lack of desire for sex and inability to become aroused. Some women may feel uncomfortable having sex while pregnant or when breastfeeding, which can be another cause.

Certain medical conditions can contribute to female sexual dysfunction. Often, treating the underlying illness can help a woman naturally regain her interest in and ability to enjoy sexual intercourse. Major illnesses like diabetes, cancer, and heart disease or blood vessel constriction can contribute to sexual dysfunction, reducing the blood flow to the vagina and labia. There’s a notable correlation between women who have a chronic heart condition and those with FSD. Medications for anxiety and depression, oral contraceptive pills, antihistamines, blood pressure medications, and chemotherapy may have side effects of lowered libido and dryness in the vagina.

Fluctuating estrogen and progesterone levels in your body can also cause a hormonally based lack of desire for sex and inability to become aroused.

Drops in the body’s estrogen levels, especially during menopause, can cause reduced blood flow to the pelvic region and changes in the tissues of your vagina, clitoris, and labia. These effects can make it harder to become aroused, naturally lubricate the inside of the vagina, and achieve orgasm.

Genital tract conditions such as endometriosis, pelvic inflammatory disease (PID), adnexal masses, large uterine fibroids, and ovarian masses may also cause dyspareunia. A hormonal imbalance due to ovarian insufficiency, thyroid dysfunction, and high prolactin blood levels may contribute to sexual dysfunction.

Sexual dysfunction is very common after sexual abuse, molestation, or rape. Professional counseling is likely the best way to help work through trauma in your past. Anxiety and depression often cause people to lose interest in sex, as does general stress in life. Relationship issues with your partner are another potential psychological cause of FSD.

While the loss of interest in sex or pain during intercourse may have many causes, there are several things that may increase your risk of developing FSD. These include:

  • Mental illness, including depression and generalized anxiety
  • Heart disease or high blood pressure (hypertension)
  • Multiple sclerosis or a spinal cord injury
  • Gynecological conditions and vulvavaginal atrophy
  • Past sexual trauma
  • Problems in your relationship
  • Obesity and poor body image issues, including eating disorders
  • Side effects of some medications

Some women may find relief through hormonal therapy, specifically estrogen. 

If FSD is caused by underlying mental illness or personal trauma, treating the condition, like taking anti-anxiety medication or pursuing counseling, may help you work through emotional reasons for being uninterested in sex.

Genital conditions that make intercourse painful can be treated depending on the condition, whether it’s topical creams, antibiotics, or, in the case of vaginal conditions that cause pain or muscle spasms, prescription medications to treat the condition.

FSD stemming from pregnancy and childbirth can include changes in the vagina itself, such as a loosening of the canal or pain in certain sexual positions. For women who have lost strength and muscle resilience after delivery, Kegel muscle exercises can help restore strength in the vagina. To perform these, squeeze your vagina muscles, kind of like you’re holding in your pee, then release. Do this for several minutes each day to rebuild the tone in the vagina.

There are multiple causes for sexual dysfunction in women, and the way you treat them varies with the reasons they occur. Remember that having trouble with sexual arousal, pain during intercourse, or a lack of sexual desire is common. Nearly half of women have problems with sex or a low libido at some point in their lives. Sexual dysfunction isn’t a cause for shame or embarrassment, although you may feel a little shy discussing these issues with your doctor or gynecologist at first. Medical treatment and/or therapy can go a long way in helping you regain your interest in and enjoyment of sex.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3008577/

https://www.merckmanuals.com/home/women-s-health-issues/sexual-dysfunction-in-women/overview-of-sexual-dysfunction-in-women

https://www.mayoclinic.org/diseases-conditions/female-sexual-dysfunction/symptoms-causes/syc-20372549

https://www.bidmc.org/centers-and-departments/obstetrics-and-gynecology/programs-and-services/center-for-intimate-health-and-wellness/types-of-female-sexual-dysfunction

https://www.nhs.uk/live-well/sexual-health/female-sexual-problems/

https://emedicine.medscape.com/article/2500107-overview

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