What is female sexual dysfunction?
Any problem involving any phase of the sexual cycle that prevents the individual or a couple from enjoying and experiencing satisfaction from the sexual activity Persistent, recurrent problems with sexual response, desire, orgasm, or pain — that distress you or strain your relationship with your partner — are known medically as sexual dysfunction.
Phases of a female sexual cycle
- Desire(commonly referred to as libido)
Causes of female sexual dysfunction:
Some of the causes of female sexual dysfunction are:
- Vasculogenic:-High Blood pressure, High cholesterol, smoking, reduced clitoral and vaginal blood flow. This causes altered estrogen levels and atrophy of the vaginal and clitoral smooth muscle
- Neurogenic:-Spinal cord injury, Diabetes Mellitus, injury to central or peripheral nerves,trauma-pelvic fractures, blunt trauma, and surgery
- Hormone/Endocrine:- altered estrogen levels, Menopause, disorders of the Hypothalamo-pituitary axis, medical or surgical castration, premature ovarian failure, chronic birth control use.Lack of estrogen and testosterone
- Musculogenic:-Muscles of the pelvic floor like levator ani, perineal membrane, ischiocavernosus and bulbospongiosus contribute to the arousal and orgasm phases-hypertonicity(exaggerated tone) of these muscles lead to painful intercourse and conditions like dyspareunia and vaginismus.Hypotonicity(low tone) of these muscles leads to less sexual sensation and a lack of orgasm
- Psychogenic:-Emotional and relationship issues: self-esteem, body image and quality of relationship with the partner, anxiety and depression
- Medications like SSRIs(selective serotonin reuptake inhibitors), medications for diabetes and hypertension, alcohol,anti-epileptics, and antipsychotics are some of the medications that can reduce sexual desire and affect orgasm.
What causes painful sex?
Painful sex, also called dyspareunia(from the Greek word Dys-bad/uncomfortable pareunos-lying beside/mate) tends to occur due to a number of reasons. This can be predominantly superficial(at the entrance) or deep(on deeper penetration and sometimes also experienced in the tummy)
Superficial causes of sexual pain: here are some examples
Lack of estrogen after menopause or sometimes after chronic use of contraception/exogenous hormones or after delivery especially during lactation, there is a lack of estrogen in the vagina which causes the “sandpaper/razor blade rubbing against the vagina” feeling during sex-this is usually at the entrance or superficial. This is due to friction and lack of lubrication and suppleness provided by estrogen. Cancer treatments like radiation/chemotherapy and surgery can also cause this
Vaginal discharge/infections and pH changes-sexually transmitted infections like gonorrhea/chlamydia or other infections like thrush or bacterial vaginosis caused due to altered pH of the vagina also can cause painful sex.
Physical causes: anatomical variants like skin tags and hymenal remnants, surgery, tears after childbirth, and prolapse can also cause this pain
Lichen sclerosis-an inflammatory skin condition of the vulva often seen more commonly in extremes of age(adolescents and menopausal women) that causes inflammation, scarring, and shrinkage of the vulval skin and can also cause painful intercourse.
Deeper causes of sexual pain: here are some examples
- Endometriosis and adenomyosis: To know more please read the Endometriosis section of the website.
- Fibroids and ovarian cysts
- Retroverted uterus(a uterus falling backwards)
Vaginismus (VAG-in-IS-MUS) is the involuntary tightening or spasm of the pelvic floor muscles which wrap around the vagina. Many women with vaginismus report pain on attempts to insert a tampon, have a cervical screening test or have sexual intercourse. Some may also report chronic pelvic pain associated with the spasm in these muscles.
It is like having an invisible wall that will not allow anything to enter inside. This is a protective reaction of the pelvic floor to protect against a previously experienced noxious stimulus, whether it be a painful sexual experience or an uncomfortable/painful medical examination. The stimulus sometimes is not even physical but can be emotional/psychological.
- Acknowledgement and validation of the woman’s experience is the first important step.
- Gentle examination often after careful counselling can confirm the diagnosis.
- Pelvic Floor physiotherapy remains the initial treatment and is aimed at relaxing the pelvic floor(opposite to what is done for pelvic organ prolapse) and preventing pelvic floor spasms.
Psychological therapies – Helping women through the psychosexual aspects of causation – whether this may involve e.g dealing with relationship issues on one end to helping women deal with previous painful and unanticipated noxious sexual stimuli on the other and managing the impact of these on sexual health.
Pelvic Floor Botox – In women where initial conservative management has failed, injection of Pelvic Floor Botox in pelvic floor muscles may help in certain selected cases to reduce the hyperactivity of the muscles and help in reducing pain and establishing sexual function.
Testosterone for postmenopausal women with HSDD(Hypoactive sexual desire disorder) – Testosterone plays an important role in libido and sexual response in women. For women after menopause who have HSDD-careful assessment is required to confirm this. In women diagnosed with HSDD, appropriate approved female testosterone preparations have an evidence base in improving sexual function.
This should be carefully monitored with validated questionnaires and blood tests to assess improvement in clinical response and should only be undertaken under medical supervision.
At Lotus Medics, we understand that sexual health is an important part of women’s health in all stages of a woman’s life and women have a right to express and enjoy sexuality in all phases of their life.
We conduct an in-depth and comprehensive analysis of the causes of female sexual dysfunction and adopt a multidisciplinary approach involving endocrinologists, physiotherapists, psychologists, GPs, and other health professionals in improving the sexual health of the woman and the relationship of the couple involved.
- Pelvic Pain Foundation of Australia
- Australasian Menopause Society
- Australian Psychological Society