Female Sexual Dysfunction

Female BodyFactors from different body systems may play a part in female sexual dysfunction. 2008 Nucleus Medical Art, Inc. Risk FactorsDefining sexual dysfunction as such is largely dependent upon your own perception of sexual difficulties and your relationship with your partner.A risk factor is something that increases your chance of getting a disease or condition. Risk factors include medical conditions or diseases, hormonal changes, side effects of medications, and psychological and social conditions. Symptoms Symptoms of sexual dysfunction include experiencing personal distress because of one or more of the following: Low sexual desireYou have a lack of interest in sex and experience poor libido.Inability to become arousedAlthough 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 disorderYou consistently have difficulty achieving sexual climax, or are unable to do so. Pain during intercourseYou experience pain during sexual stimulation and/or penetration. Vaginismus is an involuntary, painful vaginal contraction that inhibits penetration. DiagnosisYour doctor will ask about your symptoms, medical history, sexual history, and the medications you take. Your doctor will also conduct a gynecologic exam.

The diagnostic process may include: Swabs of vaginal fluid to evaluate for infection or bacterial imbalanceCervical swabs to test for sexually transmitted diseases (STDs)Urine testsA pelvic exam to check for signs of physical changes, including thinning of genital tissues, decreased skin elasticity, and scarringA psychological evaluation of possible contributing factors, such as anxiety, depression, past sexual abuse, and relationship problems TreatmentBecause of the multifactorial nature of 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 effectsTreating depression and anxietyUsing vaginal lubricants to relieve dyspareunia, vaginal dryness, and irritation Possible hormone therapiesThese include estrogen replacement therapy (ERT) and androgen therapy. For women with other estrogen-depleting conditions, transdermal estrogen supplementation (topical estrogen cream, vaginal ring, vaginal tablet) can also help with vaginal irritation, pain, or dryness. Estrogen replacement therapy (oral, skin patch) may help with arousal disorder. There is an absence of evidence that estrogen supplementation alone will benefit sex drive/libido. However, a subset of women may benefit from this intervention.Androgen therapy includes the controversial use of testosterone treatment for sex drive/libido. The treatment is not approved by the US Food and Drug Administration (FDA) at this time and is only to be used under medical supervision. Nonmedical treatments improve sexual health and decreased desire. These include:

Working with a sex therapistMaking lifestyle changes to improve your overall health (for example, 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, the steps below will help you avoid certain risk factors. If a medical condition is the cause, follow the treatment.If medications are the problem, ask your doctor about changing the medication or the regimen.Avoid emotional stress.If interpersonal conflict is the cause, try relationship counseling. RESOURCES: American Academy of Family Physicianshttp://www.aafp.org American College of Obstetricians and Gynecologistshttp://www.acog.org Cleveland Clinic Foundationhttp://www.clevelandclinic.org/health Mayo Foundation for Medical Education and Researchhttp://www.mayoclinic.com/health CANADIAN RESOURCES: The Canadian Women's Health Networkhttp://www.cwhn.ca/indexeng.html The Society of Obstetricians and Gynaecologists of Canadahttp://sogc.medical.org/ References: 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.

Cleveland Clinic Foundation website. Available at: http://www.clevelandclinic.org/health.. Dr. Laura Berman website. Available at: http://www.drlauraberman.com/PublicSite/Index.aspx and http://www.bermancenter.com/.. Mayo Foundation for Medical Education and Researchwebsite. Available at: http://www.mayoclinic.com/health.. The Merck Manual of Diagnosis and Therapy webite. Available at: http://www.merck.com/pubs/mmanual/section18/chapter243/243a.htm. Accessed October 13, 2005. Phillips NA. Female sexual dysfunction: evaluation and treatment. Am Fam Physician . 2000 Jul 1;62(1). Available at: http://www.aafp.org/afp/20000701/127.html.. Last reviewed May 2008 by Ganson Purcell Jr., MD, FACOG, FACPEPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.