Female Sexual Dysfunction: Definitions, Causes & Potential Treatments

Written by HealthyPlace.com Staff Writer

Female Sexual dysfunction is age-related, progressive and highly prevalent affecting 30-50 percent of women^(1,2,3). Based on the National Health and Social Life Survey of 1,749 women, 43 percent experienced sexual dysfunction.⁽⁴⁾ U.S. population census data reveal that 9.7 million American women ages 50-74 self-report complaints of diminished vaginal lubrication, pain and discomfort with intercourse, decreased arousal, and difficulty achieving orgasm. Female sexual dysfunction is clearly an important women's health issue that affects the quality of life of many of our female patients.

Until recently, there has been little research or attention that focuses on female sexual function. As a result, our knowledge and understanding of the anatomy and physiology of the female sexual response is quite limited. Based on our understanding of the physiology of the male erectile response, recent advances in modern technology, and recent interest in Women's Health issues, the study of female sexual dysfunction is gradually evolving. Future advances in the evaluation and treatment of female sexual health problems are forthcoming.

The Female Sexual Response Cycle:

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Masters and Johnson first characterized the female sexual response in 1966 as consisting of four successive phases; excitement, plateau, orgasmic and resolution phases⁽⁵⁾. In 1979, Kaplan proposed the aspect of "desire", and the three-phase model, consisting of desire, arousal, and orgasm⁽⁶⁾. However, in October, 1998, a consensus panel made up of a multidisciplinary team treating female sexual dysfunction met to create new a new classification system that all professionals treating Female Sexual dysfunction can use.

1998 AFUD Consensus Panel Classifications & Definitions of Female Sexual Dysfunction

• Hypoactive Sexual Desire Disorder: persistent or recurring deficiency (or absence) of sexual fantasies/thoughts, and/or receptivity to, sexual activity, which causes personal distress.
• Sexual Aversion Disorder: persistent or recurring phobic aversion to, and avoidance of sexual contact with a sexual partner, which causes personal distress. Sexual Aversion Disorder is generally a psychologically or emotionally based problem that can result for a variety of reasons such as physical or sexual abuse, or childhood trauma, etc.
• Hypoactive Sexual Desire Disorder may result from psychological/emotional factors or be secondary to medical problems such as hormone deficiencies, and medical or surgical interventions. Any disruption of the female hormonal system caused by natural menopause, surgically or medically induced menopause, or endocrine disorders can result in inhibited sexual desire.
• Sexual Arousal Disorder: persistent or recurring inability to attain, or maintain sufficient sexual excitement causing personal distress. It may be experienced as lack of subjective excitement or lack of genial (lubrication/swelling) or other somatic responses.

Disorders of arousal include, but are not limited to, lack of or diminished vaginal lubrication, decreased clitoral and labial sensation, decreased clitoral and labial engorgement or lack of vaginal smooth muscle relaxation.

These conditions may occur secondary to psychological factors, however often there is a medical/physiologic basis such as diminished vaginal/clitoral blood flow, prior pelvic trauma, pelvic surgery, medications (i.e. SSRI) ^(7,8)

• Orgasmic Disorder: persistent or recurrent difficulty, delay in, or absence of attaining orgasm following sufficient sexual stimulation and arousal, and causes personal distress.

This may be a primary (never achieved orgasm) or secondary condition, as a result of surgery, trauma, or hormone deficiencies. Primary an orgasmia can be secondary to emotional trauma or sexual abuse, however medical/physical factors can certainly contribute to the problem.

• Sexual Pain Disorders:
  • Dyspareunia: recurrent or persistent genital pain associated with sexual intercourse
  • Vaginismus: recurrent or persistent involuntary spasm of the musculature of the outer third the vagina that interferes with vaginal penetration, which causes personal distress.
• Other sexual pain disorders: Recurrent or persistent genital pain induced by non-coital sexual stimulation. Dyspareunia can develop secondary to medical problems such as vestibulitis, vaginal atrophy, or vaginal infection can be either physiologically or psychologically based, or a combination of the two. Vaginismus usually develops as a conditioned response to painful penetration, or secondary to psychological/emotional factors.

Role of Hormones in Female Sexual Function:

Hormones play a significant role in regulating female sexual function. In animal models, estrogen administration results in expanded touch receptor zones, suggesting that estrogen effects sensation. In post-menopausal women, estrogen replacement restores clitoral and vaginal vibration and sensation to levels close to those of pre-menopausal women⁽¹⁵⁾. Estrogens also have protective effects which result in increased blood flow to the vagina and clitoris ^(15,16). This helps to maintain female sexual response over time.

With aging and menopause, and the decreasing estrogen levels, a majority of women experience some degree of change in sexual function. Common sexual complaints include loss of desire, decreased frequency of sexual activity, painful intercourse, diminished sexual responsiveness, difficulty achieving orgasm, and decreased genital sensation.

Masters and Johnson first published their findings of the physical changes occurring in menopausal women that related to sexual function in 1966. We have since learned that symptoms of low lubrication and poor sensation are in part secondary to declining estrogen levels, and that there is a direct correlation between the presence of sexual complaints and low levels of estrogen⁽¹⁵⁾. Symptoms markedly improve with estrogen replacement.

Low testosterone levels are also associated with a decline in sexual arousal, genital sensation, libido, and orgasm. There have been studies that have documented improvements in women's desire when treated with 100 mg testosterone pellets ^(17,18). At this time, there are not Food and Drug Administration (FDA) approved testosterone preparations for women; however clinical studies are underway assessing the potential benefits of testosterone for the treatment of female sexual dysfunction.