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Female Sexual Health

Female Sexual Dysfunction

This is an abbreviated version of the complete article.*

Basic Facts
  • Female sexual dysfunction is much more common than was previously thought.
  • Complaints of female sexual dysfunction are more prevalent in older women than in younger women.
  • Medical conditions, such as vascular disease, can cause direct or indirect sexual difficulties.
  • Treatment for sexual dysfunction always includes education to become more knowledgeable about sex and normal sexual function.
Female sexuality is a complicated process, influenced by psychological and physical factors. A woman's attitudes toward her body, the sexual act, and her partner can cause sexual dysfunction. Physical factors such as brain function, the health of the circulatory system, and hormone levels are also major influences. Experts categorize sexual dysfunction as one or more of the following:
  • Decreased libido or sexual desire;
  • Orgasmic disorder such as anorgasmia or lack of orgasm;
  • Painful intercourse or dyspareunia; and
  • Vaginal dryness or decreased lubrication.


CAUSES AND RISK FACTORS

Loss of libido: Menopause, with its drop in estrogen and testosterone levels, may decrease a woman's sexual desire. Some other potential causes include:
  • Medications, such as antidepressants
  • Chemotherapy
  • Depression
  • Alcohol abuse
  • Stress
  • Anorgasmia: Some potential causes of anorgasmia may include:
  • Lack of sexual experience
  • Psychological inhibitions
  • Medication use
  • Chronic disease
Painful intercourse: Potential causes of painful intercourse may include:
  • Lack of lubrication
  • Vaginismus
  • Vaginal atrophy
  • Vulvodynia
  • Congestion, adhesion, or infection of the pelvis or associated organs
  • Endometriosis
  • Vaginal yeast infections
  • Urinary disorders, such as cystitis, or bladder infection
Vaginal dryness: Changes in estrogen level can cause vaginal dryness. Other potential causes may include:
  • Douching
  • Chemotherapy or radiation therapy
  • Medications, such as contraceptives or cold medicines
  • Certain illness, such as diabetes mellitus
  • Stress or anxiety
Factors that can contribute to sexual dysfunction in general may include:
  • Lack of sexual education
  • Psychological factors, such as fear of failure
  • Nerve disorders, such as Parkinson's disease
  • Circulatory disorders
  • Medications, such as tranquilizers or anti-anxiety agents
  • Alcohol; and Degenerative health conditions, such as chronic renal failure

DIAGNOSIS

To determine the exact nature of a female sexual dysfunction problem, a physician will ask a patient about her medical and sexual history. Next, the physician will examine the patient for any physical abnormalities or indications of the medical conditions associated with sexual dysfunction. This examination may include:
  • Blood tests
  • Urine tests
  • A pelvic examination
  • X rays
  • Endoscopic examination

TREATMENT APPROACH

Loss of libido: Currently no medications can increase sexual desire in women. If no physical reason can be found for loss of desire, a physician may suggest that a woman seek individual or couples counseling. During menopause, testosterone supplementation has shown success in reinvigorating a woman's sex drive.

Anorgasmia: Treatment might include:
  • Relaxation techniques
  • Using masturbation or a vibrator to improve sexual responsiveness
  • Muscular control of sexual tension
  • Distraction
  • Painful intercourse: Some treatment methods may include:
  • Topical vaginal estrogen cream
  • Antidepressants or antispasmodics
  • Genital or clitoral suction devices
  • Behavior therapy and vaginal relaxation exercises
  • Proper hygiene
Vaginal dryness: Treatments may include one or more of the following:
  • Increased foreplay
  • Over-the-counter lubricants
  • Topical vaginal estrogen creams
  • Hormone replacement therapy
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