What is sexual dysfunction?
Sexual dysfunction refers to a problem during any phase of the sexual response cycle
that prevents the individual or couple from experiencing satisfaction from the
sexual activity. The sexual response cycle has four phases: excitement, plateau,
orgasm and resolution.
What causes sexual dysfunction?
Causes of sexual dysfunction include:
- Physical causes — Many physical and/or medical conditions can cause
problems with sexual function. These conditions include diabetes, heart
disease, neurological disorders, hormonal imbalances, menopause, chronic
diseases such as kidney or liver failure, and alcoholism and drug abuse. In
addition, the side effects of certain medications, including some
antidepressants 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.
How does sexual dysfunction affect women?
The most common problems related to sexual dysfunction in women include:
- Inhibited sexual desire — This involves a lack of sexual desire
or interest in sex. Many factors can contribute to a lack of desire,
including hormonal changes, medical conditions and treatments (for example
cancer and chemotherapy), depression, pregnancy, stress and fatigue. Boredom
with regular sexual routines also may contribute to a lack of enthusiasm for
sex, as can lifestyle factors, such as careers and the care of children.
- Inability to become aroused — For women, the inability to become
physically aroused during sexual activity often involves insufficient
vaginal lubrication. The inability to become aroused also may be related to
anxiety or inadequate stimulation. In addition, researchers are
investigating how blood flow disorders affecting the vagina and clitoris may
contribute to arousal problems.
- Lack of orgasm (anorgasmia) — This is the delay or absence of
sexual climax (orgasm). It can be caused by sexual inhibition, inexperience,
lack of knowledge and psychological factors such as guilt, anxiety, or a
past sexual trauma or abuse. Other factors contributing to anorgasmia
include insufficient stimulation, certain medications and chronic diseases.
- Painful intercourse — Pain during intercourse (dyspareunia) can
be caused by a number of problems, including endometriosis, pelvic mass,
ovarian cysts, inflammation of the vagina (vaginitis), poor lubrication, the
presence of scar tissue from surgery and a sexually transmitted disease. A
condition called vaginismus is a painful, involuntary spasm of the muscles
that surround the vaginal entrance. It may occur in women who fear that
penetration will be painful and also may stem from a sexual phobia or from a
previous traumatic or painful experience.
How is female sexual dysfunction diagnosed?
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 test to detect changes in the cells of the
cervix (to check for cancer or a pre-cancerous condition). He or she may order
other diagnostic tests to rule out any medical problems that may be contributing
to the dysfunction.
An evaluation of the person’s 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.
How is female sexual dysfunction treated?
The ideal approach to treating female sexual dysfunction involves a team effort
between the patient, health care providers and trained therapists. Most types of
sexual dysfunction can be corrected by treating the underlying physical or
psychological problems. Other treatment strategies focus on the following:
- Providing education — Education about human anatomy, sexual
function and the normal changes associated with aging, as well as sexual
behaviors and responses, may help a woman overcome her anxieties about sexual
function and performance.
- Enhancing stimulation — This may include the use of erotic
materials (videos or books), masturbation and changes to sexual routines.
- Providing distraction techniques — Erotic or non-erotic fantasies;
exercises with intercourse; music, videos or television can be used to
increase relaxation and eliminate anxiety.
- Encouraging non-coital behaviors — Non-coital behaviors
(physically stimulating activity that does not include intercourse), such as
sensual massage, can be used to promote comfort and increase communication
between partners.
- Minimizing pain — Using sexual positions that allow the woman to
control the depth of penetration may help relieve some pain. The use of
vaginal lubricants can help reduce pain caused by friction, and a warm bath
before intercourse can help increase relaxation.
How do hormones affect sexual function?
Hormones play an important role in regulating sexual function in women. With the decrease
in the hormone estrogen that is related to aging and menopause, many women
experience some changes in sexual function as they age. Poor vaginal lubrication
and decreased genital sensation are problems associated with changes in estrogen
levels. Further, research suggests that low levels of the hormone testosterone
also contribute to a decline in sexual arousal, genital sensation and orgasm.
Researchers still are investigating the benefits of hormones and other
medications, including sildenafil (Viagra), to treat sexual dysfunction in women.
What effect does a hysterectomy have on sexual function?
Many women experience changes in sexual function after a
hysterectomy. These changes may include a loss of desire, and decreased vaginal
lubrication and genital sensation. These problems may be associated with the
hormonal changes that occur with the loss of the uterus and ovaries. Further,
nerves and blood vessels critical to sexual function can be damaged during the
hysterectomy procedure.
How does menopause affect a woman’s sexual function?
The loss of estrogen following menopause can lead to
changes in a woman’s sexual functioning. Emotional changes that often
accompany menopause can add to a woman’s loss of interest in sex and/or
ability to become aroused. Hormone replacement therapy may improve certain
conditions, such as loss of vaginal lubrication and genital sensation, that can
create problems with sexual function.
It should be noted that some post-menopausal women report an increase in
sexual satisfaction. This may be due to decreased anxiety associated with a fear
of pregnancy. In addition, post-menopausal woman often have fewer child-rearing
responsibilities, allowing them to relax and enjoy intimacy with their partners.
When should I call my health care provider?
Many women experience a problem with sexual function from time to time. However, when
the problems are persistent, they can cause distress for the women and her
partner, and have a negative impact on their relationship. If you consistently
experience these problems—especially pain during intercourse—for more than a
few months, see your health care provider for evaluation and treatment.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/1/2007...#9123
