Female Sexual Dysfunction

February 8, 2017

Female sexual dysfunction is a complex and poorly understood condition that affects women of all ages. Sexual dysfunction is defined as a disturbance in, or pain during, the sexual response. This problem is more difficult to diagnose and treat in women than it is in men because of the intricacy of the female sexual response. A woman has female sexual dysfunction, also called FSD, when she is upset or unhappy about her sexual health.

Sexual activity includes a wide variety of intimate activities, such as fondling, self-stimulation, oral sex, vaginal penetration and intercourse. Every woman differs in her sexual interest, response and expression. A woman’s feelings about sexuality can change according to the circumstances and stages of her life. Women also can experience a variety of sexual problems, such as lack of desire, difficulty becoming aroused, difficulty having an orgasm or pain during sex. When a physical or emotional problem associated with sex persists, it’s time to contact a health care professional.

Sexual Dysfunction can be described as –

  • Low Sexual Desire – Diminished libido, or lack of sex drive.
  • Sexual Arousal Disorder – The desire for sex might be intact, but may have difficulty or are unable to become aroused or maintain arousal during sexual activity.
  • Orgasmic Disorder – Women may have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.
  • Sexual Pain Disorder – Women may have pain associated with sexual stimulation or vaginal contact.
  • Low Libido Associated with Menopause 

A woman’s sexuality is a complex interplay of physical and emotional responses that affects the way she thinks and feels about herself. When a woman has a sexual problem, it can impact many aspects of her life, including her personal relationships and her self-esteem. Many women are hesitant to talk about their sexuality with their health care professionals, and many health professionals are reluctant to begin a discussion about sexuality with their patients. Instead, women may needlessly suffer in silence when their problems could be treated.

A woman might have more than one of these issues, which are often related to each other.  Sexual dysfunction can be lifelong or temporary.  It can happen all the time, only with a certain partner, or only at certain times, such as after pregnancy. A healthy sex life depends on a complex mix of many factors.  The same is true for a troubled sex life. Health issues, certain prescription medicines, changes in hormone levels, partner or family issues, and psychological concerns can all contribute to FSD.

Types of Sexual Dysfunctions

Hypoactive Sexual Desire Disorder – When sexual fantasies or thoughts and desire for sexual activity are persistently reduced or absent causing distress or relationship difficulties, the problem is known as hypoactive sexual desire disorder, or inhibited sexual desire disorder. The Merck Manual estimates hypoactive sexual desire disorder occurs in about 20 percent of women.

Sexual aversion disorder: Diagnosed when a women avoids all or almost all genital sexual contact with a sexual partner to the point that it causes personal distress and relationship difficulties. This condition may affect women who have experienced some type of sexual abuse or who grew up in a rigid atmosphere in which sex was taboo.

Sexual arousal disorder – The persistent or recurrent inability to reach or sustain the lubrication and swelling reaction in the arousal phase of the sexual response to the point that it causes personal distress. It is the second most common sexual problem among women, affecting an estimated 20 percent of women, and most frequently occurs in postmenopausal women. Low estrogen levels after menopause can make vaginal tissue dry and thin and reduce blood flow to genitals.

Female orgasmic disorder – The persistent absence or recurrent delay in orgasm after sufficient stimulation and arousal, causing personal distress. According to the Association of Reproductive Health Professionals, 24 to 37 percent of women have problems reaching orgasm. Most women are biologically able to experience orgasm. Never having an orgasm, or not having one in certain situations, are problems that can often be resolved by learning how the female body responds, how to ensure adequate stimulation and/or how to overcome inhibitions or anxieties.


Once thought to be purely psychological, doctors now know the causes of female sexual dysfunction can be physical, psychological or both. It’s important to rule out physical causes in order to properly address hormonal causes, psychological causes and social causes.

These are some of the possible physical causes of female sexual dysfunction –

  • Nerve damage caused by trauma or surgery
  • Infection in the pelvis
  • Gynecological disease
  • Lubrication insufficiency
  • Fatigue
  • Heart disease
  • Diabetes
  • Hormone causes and imbalances
  • Menopause hormonal changes
  • Insufficient stimulation
  • Medications that decrease sex drive

Psychological causes and social causes of female sexual dysfunction include the following –

  • Anxiety about sexual intercourse or anxiety disorders
  • Partner-to-partner communication problems
  • Fear of pain, pregnancy or infection caused by sexual intercourse
  • Feeling guilty or shameful
  • Stress
  • Fatigue
  • Depression
  • Marriage/relationship problems

Interpersonal relationship causes may include –

  • Partner performance and technique
  • Lack of a partner
  • Relationship quality and conflict
  • Lack of privacy

Sociocultural influence causes may include –

  • Inadequate education
  • Conflict with religious, personal, or family values
  • Societal taboos

While periodic female sexual dysfunction can be normal, a physician should examine lasting symptoms. Some females are at a higher risk for developing dysfunction. Risk factors include past sexual abuse, including rape.

Risk Factors

Risk may increase if the women –

  • Single, divorced, widowed or separated
  • Not a high school graduate
  • Experiencing emotional or stress-related problems
  • Experiencing a decline in the economic position
  • Feeling unhappy, or physically and emotionally unsatisfied
  • A victim of sexual abuse or forced sexual contact


Up to 70% of couples have a problem with sex at some time in their relationships. Most women will have sex that doesn’t feel good at some point in her life. This doesn’t necessarily mean the women has a sexual problem.

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.


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.

Hormonal treatment

  • Estrogen therapy – Localized estrogen therapy comes in the form of a vaginal ring, cream or tablet. This therapy benefits sexual function by improving vaginal tone and elasticity, increasing vaginal blood flow and enhancing lubrication.
  • Androgen therapy – Androgens include testosterone. Testosterone plays a role in healthy sexual function in women as well as men, although women have much lower amounts of testosterone.

Other medicines

  • Non-prescription treatments, which are hormone-free and have few side effects, can help. They include moisturizers applied to the vagina several times a week or lubricants for the vagina, used just before intercourse.
  • Testosterone, when used short-term (a year or two), may increase sex drive in some women. Testosterone products for women are approved in some countries but not in the U.S.  The long-term safety of testosterone for women has not been proven and is being studied.

Devices – A prescription device called the Eros can help with arousal by increasing blood flow to the genital area and enhancing sensation.

Complementary & Alternative Treatment

Vitamin C may help both men and women, as it increases blood flow. One study suggests vitamin C may increase libido in women.

Essential fatty acids, found in evening primrose oil, fish oil, and borage oil, help improve blood flow.

Dehydroepiandrosterone (DHEA), a hormone made by the body’s adrenal glands, has been studied for both men and women. DHEA levels get lower as women grow older.

L-arginine is an amino acid that has numerous functions in the body. It is needed by the body to make nitric oxide, a compound that helps to relax blood vessels and allow blood to flow through arteries.

Ginkgo biloba is a herb used for centuries in traditional Chinese medicine as a folk remedy for respiratory conditions, cognitive impairment, and circulatory disorders.

Yohimbe – The bark of the herb yohimbe (Pausinystalia yohimbe) was historically used as a folk remedy for sexual dysfunction. The active constituent in the bark is called yohimbine.

Damiana (Turnera diffusa) is a herb used traditionally by the Mayan people of Central America to enhance sexual function in men and women. It is reported to be an aphrodisiac, stimulant, mood enhancer, and a tonic.

Tribulus terrestris – Studies of women who use this herb report greater desire, increased arousal, lubrication, more intense orgasms, and satisfaction.

Suma root – Sometimes called Brazilian Ginseng, this herb is extremely popular with the native population in South America for the way it aids female hormonal balance and excites libido. Science has confirmed suma root increases levels of estradiol-17beta, the primary estrogen hormone during a woman’s reproductive years.

Avena sativa – Generations of women stand by oats (Avena sativa) for its aphrodisiac and libido-stimulating qualities.

Acupuncture is the practice of inserting tiny needles into pressure points all over the body. In traditional Chinese theory, the purpose of acupuncture is to rebalance the energy flow of the body. Many women have claimed that acupuncture has helped decrease sexual pain during intercourse.

Meditation is another way in which women can feel more in touch with themselves and their bodies. Practicing controlled breathing and experiencing the ability to “just be” without life stressors or external judgment has shown to have positive results with their sexuality.


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