WOMEN SEXUAL DYSFUNCTION

WOMEN SEXUAL DYSFUNCTION

loss of sexual desire or arousal, discomfort during intercourse, diminished blood flow to the vagina, trauma-related aversion to sex, and the inability to achieve orgasm. Historically, psychiatrists and sex therapists have diagnosed and treated these disorders, perhaps, in many cases, according to limited perspectives maintained by psychiatric literature. Urologists and gynecologists now treating female sexual problems that result from medical conditions causing diminished pelvic and vaginal blood flow and nerve damage.

While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.

Researchers used standard measures to evaluate sexual functioning and had the women sexual health activity log. They also assessed hormone levels.

Concepts of women sexual dysfunction are controversial, particularly those based on biological causes. The American Psychological Association (APA) classifies female sexual problems as mental disorders: loss of sexual desire or arousal, discomfort during intercourse, diminished blood flow to the vagina, trauma-related aversion to sex, and the inability to achieve orgasm. Historically, psychiatrists and sex therapists have diagnosed and treated these disorders, perhaps, in many cases, according to limited perspectives maintained by psychiatric literature. Urologists and gynecologists now treating female sexual problems that result from medical conditions causing diminished pelvic and vaginal blood flow and nerve damage.

Currently, urologists, behavioral scientists, and psychologists are looking at medical, cultural, psychological, and relational reasons for women's sexual dysfunction, perhaps more accurately termed sexual dissatisfaction. They are emphasizing education and communication between partners. Surveys of women suggest that therapy should focus on women's physiological needs to experience enjoyable sex instead of medical conditions. Under this view, women sexual dissatisfaction is symptomatic of an intimacy problem in which one or both partners fail to communicate their needs.

A useful model for exploring disturbances in women sexual response considers traditional and innovative, psychiatric and medical, and psychological and physiological perspectives. For some women, dysfunction or dissatisfaction is defined by a loss of interest in sex (low libido) and the inability to become aroused or to achieve orgasm when participating in sex. Many are dissatisfied because their partners are uneducated or inattentive and do not understand female arousal and its anatomical basis. For others, a medical evaluation uncovers a physiological problem that impairs sensitivity. The concept of female sexual dysfunction, or dissatisfaction, remains poorly defined.

A survey conducted by the American Medical Association in 1999 indicates that women sexual dysfunction affects approximately 43% of women in the United States. Age may not be a significant factor, as women under 20 and over 50 experience problems with arousal, orgasm, and satisfaction. However, there is evidence that the majority of female sexual dysfunction happens after menopause, when hormone production drops and vascular conditions are more common.

Cycle of sexual Response in women | Women Sexual Dysfunction

Clinical and empirical studies, mainly of North American and European adult women without sexual complaints, have clarified sexual response cycles that are different from the linear progression of discrete phases already mentioned. Women describe overlapping phases of women sexual response in a variable sequence that blends the responses of mind and body. Those women have many reasons for initiating or agreeing to sex with their partners is an important finding. Women's sexual motivation is far more complex than simply the presence or absence of sexual desire (defined as thinking or fantasizing about sex and yearning for sex between actual sexual encounters).

Recent baseline data from a longitudinal study of 3300 multi-ethnic, premenopausal North American women aged 42 to 52 who had not recently received medication affecting reproductive hormones and who had engaged in women sexual activity with a partner during the past 6 months clarified their reasons both to engage sexually (to express love, for pleasure, because the partner wanted to, to relieve tension) and to refrain (lack of interest, tiredness or physical problems [their own or their partner's], or no current partner).

At the beginning of a given sexual experience, a woman may well sense no sexual desire per se. Her motivations to be sexual are complex and include increasing emotional closeness with her partner (emotional intimacy) and often increasing her own well-being and self-image (sense of feeling attractive, feminine, appreciated, loved and/or desired, or to reduce her feelings of anxiety or guilt about sexual infrequency).

When a woman is willing to become aroused and enjoy a sexual experience, she focuses on the sexual stimulation which her partner supplies. If the stimulation is as she wishes, sufficient time is available and she can stay focused, her sexual excitement and pleasure intensify. Clearly, the type of stimulation, the time needed and the context (both erotic and interpersonal) are all highly individual. Emotionally and physically positive outcomes will increase subsequent motivation.

Some women report desire that appears to be spontaneous leading to arousal or to more enthusiasm to find or be receptive to sexual stimuli. This type of desire has a broad spectrum across women and may be related to the menstrual cycle. It decreases with age and at any age commonly increases with a new relationship.

Previous definitions of women's sexual dysfunctions unfortunately assumed that the cycle of a woman's sexual response always began with sexual desire, sexual thoughts and fantasies, and that their absence was evidence of a disorder. In a 1992 survey of American adults, the most common women sexual dysfunction among women 18 to59 years of age was low desire, reported by just under a third of those surveyed, with little variation by age. Such results have remained consistent across studies. It is unclear how many of these women are simply reporting low or absent spontaneous desire but do experience triggered desire during sex. Moreover, women report that sexual fantasies can be deliberate at a means to stay focused on the sexual stimulus, rather than an indication of sexual desire.

Another important finding is that the robust correlation seen in men between subjective arousal and genital congestion (erection) is not seen in women. Rather, sexual arousal in women is more strongly modulated by thoughts and emotions triggered by the state of sexual excitement. In women, photoplethysmography can be used to measure vaginal vasocongestion and hence to gauge physiological arousal. Female study participants subjected to erotic (usually visual) stimuli can meanwhile report their subjective responses (sexual arousal and positive and negative emotions) by using a Likert scale or a lever that can be moved from left (low arousal) to right (high arousal). In psycho physiological response studies, women with arousal disorders, despite a lack of subjective arousal and perception of "lack of lubrication/swelling response" while watching erotic videos, showed increases in vasocongestion comparable to those in control participants without such disorders. Only the women in the control group reported subjective arousal while watching the videos. Previous definitions of arousal disorder focused only on genital lubrication and/or swelling response ignoring 25 years of research showing the poor correlation of genital engorgement with the woman's subjective arousal and excitement in response to sexual stimulation.

Causes of Sexual Dysfunction in Women | Women Sexual Dysfunction

The causes of female sexual dysfunction are poorly defined. Several factors may impede the women sexual response cycle, which requires physical and psychological stimulation: - 

(1) Alcohol

(2) Anxiety

(3) Depression

(4) Emotional problems; distraction

(5) Illness

(6) Negative body perception

(7) Stress

Recently, controversy has produced two opposing medical perspectives on the causes (and treatment) for women sexual dysfunction. One concept, known as the vascular theory, is that diminished blood flow to the pelvic region, due to a medical condition, aging, stress, or hypoactive sexual desire, causes reduced sensitivity (particularly of the clitoris) and dryness, and impairs arousal. Decreased blood flow is associated with medical conditions such as diabetes and atherosclerosis. This concept has fueled clinical research and has led to the introduction of topical creams that, when applied to the clitoris, cause vascular dilation, increased blood flow, and vascular congestion associated with the excitement stage. Sensitivity is increased and may lead to arousal.

A second concept, the hormone theory, focuses on decreased levels of sex hormones, such as estrogen and testosterone, caused by aging. For some women, hormone replacement therapy leads to greater sexual desire. Estrogen, a primarily female hormone, is associated with sexual desire. Testosterone, a primarily male sex hormone, plays a role in women's sexual development and function, including sensitivity of the breasts and clitoris. Some women experience diminished sexual desire, absence of sexual fantasies, and impaired sensitivity following menopause or hysterectomy as a result of reduced estrogen.

Other medical causes include the following:  -

(1) Bicycle riding (long narrow seats associated with perineal pressure and reduced blood flow)

(2) Drugs and medications; birth control pill

(3) Smoking

(4) Spinal cord injury (can cause nerve damage; paralysis)

(5) Surgery (of or near reproductive-urinary system or abdomen; may damage nerves)

(6) Urinary incontinence (can cause embarrassment, avoidance)

(7) Vaginal atrophy

Antidepressants and benzodiazepines (fluoxetine, Prozac, alprazolam, Xanax) used to treat depression and anxiety are the drugs most commonly associated with loss of libido and inability to achieve orgasm. Buproprion (Wellbutrin, an antidepressant) is sometimes prescribed for those who experience drug-related loss of sexual desire. Some evidence suggests that it restores libido. Chemotherapy drugs used to treat cancer are also associated with a lack of sexual interest. Some evidence suggests that extended use of birth control pills leads to reduced libido. Spinal cord injury, pelvic trauma, and other conditions that affect the peripheral nervous system, such as diabetes, can impair genital sensitivity, as can surgery involving the pelvic floor, bladder, abdomen, and genitals.

A third perspective, what could be called the dissatisfaction theory is neither psychological nor medical. A great deal of women's sexual dysfunction is not caused by hormone deficiency or diminished pelvic blood flow; it results from inadequate genital stimulation. The fact that young, healthy women experience sexual dysfunction gives credence to this view. Poor communication by both partners may result in men not knowing how to stimulate a woman so that she becomes aroused. This leads to unsatisfactory sex and can cause arousal problems, lack of sexual interest, depression, and aversion to sex. Interestingly, the APA lists the "adequacy of female sexual stimulation" as a factor only in its discussion of female orgasmic disorder. This implies that it is not a fundamental aspect of female sexual function and so not affected by medical or psychological conditions.

So finally the causes were classified into Physical & Psychological Causes: -

Physical causes: - Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart disease, neurological diseases, hormonal imbalances, menopause, and chronic diseases such as kidney disease or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.

Psychological causes: - These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.

Diagnosis for Female Sexual Dysfunction | Women Sexual Dysfunction

The doctor likely will begin with a physical exam and a thorough evaluation of symptoms. The doctor may perform a pelvic examination to evaluate the health of the reproductive organs and a Pap smear to detect changes in the cells of the cervix (to check for cancer or a pre-cancerous condition). He or she may order other tests to rule out any medical problems that may be contributing to the woman's sexual dysfunction.

An evaluation of your attitudes regarding sex, as well as other possible contributing factors (fear, anxiety, past sexual trauma/abuse, relationship problems, alcohol or drug abuse, etc.) will help the doctor understand the underlying cause of the problem and make appropriate recommendations for treatment.

Treatment for Female Sexual Dysfunction

There are three primary types of experimental treatment for female sexual dysfunction:  -

(1) Education on female anatomy, arousal, and response; where blood flow, hormone levels, and sexual anatomy are normal.

(2) Hormone replacement therapy (including treatment of the underlying disorder)

(3) Vascular treatment (including treatment of the underlying disorder)

Education

Educating both women and men on how to talk about and respond to a woman's psychological and physical stimulatory needs can only happen if both partners recognize that there is a problem. Behavioral and sex therapists note the need for partners to examine the actual act of having sex, including foreplay, intercourse, and talking about sex. Sex therapists and psychologists may assist in improving communication between partners.

Hormone replacement therapy

Hormone replacement therapy (HRT) is aimed at restoring hormone levels affected by age, surgery, or hormone dysfunction to normal, thus restoring sexual function. Estrogen and testosterone levels are measured and treated by endocrinologists.

Vascular treatments

A medical condition that causes diminished blood flow to the vagina (e.g., diabetes) must be addressed in light of female sexual dysfunction. However, some women who are not diagnosed with underlying medical conditions have found that nonprescription topical creams and gels, such as Sensual formerly called Viacreme increase sensitivity and assist in achieving orgasm.

Sensual

Sensual is an amino-acid based (L-arginine) solution that contains menthol. L-Arginine is involved in nitric oxide synthesis, which is responsible for vascular and nonvascular smooth muscle relaxation. When applied to the clitoris, Sensual may increase blood flow by dilating clitoral blood vessels. More research is being done to assess the possible effects and complications of topical creams.

Sildenafil (Viagra)

Sildenafil (Viagra), used in men with erectile dysfunction, is currently being tested in women. Some evidence suggests that it may restore libido lost to antidepressant use.

Eros Therapy

Eros Therapy is an FDA-approved device for the treatment of female sexual dysfunction. This small handheld device is used 3 to 4 times per week to increase blood flow to the clitoris and external genitalia, which improves clitoral and genital sensitivity, lubrication, and the ability to experience orgasm. It may take several weeks of conditioning before experiencing the benefits of this therapy.