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.

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 do hormones affect sexual function in women?

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.

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.

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.

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.