Female sexual dysfunction

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 23, 2016
StartDiseasesFemale sexual dysfunction

Female sexual dysfunction is a source of psychological stress and depression for many women across the world. The Diagnostic and Statistical Manual of Mental Disorders (DSM) identifies female sexual interest/arousal disorder (FSIAD) as a condition in which both desire and arousal are reduced.


Definition & Facts

Female sexual dysfunction involves recurring dysfunction in response to sex and sexual relationships. Dysfunction may include pain, lack of libido, lack of orgasm, and lack of desired physical response. Research studies have shown that about 40% of women experience female sexual dysfunction at some stage in life. It may manifest itself early in life or later in life depending on the woman.

Female sexual dysfunction used to be categorized as two separate conditions: hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD). Whereas the former described lack of sexual interest and the latter described lack of sexual arousal, both conditions have been merged into one classification in the DSM: female sexual interest/arousal disorder.

Female sexual interest/arousal disorder is diagnosed when an individual experiences dysfunction for at least six months and the dysfunction causes the individual significant distress, among other diagnostic criteria.

Symptoms & Complaints

Symptoms of female sexual dysfunction include painful intercourse. Another symptom could be vaginismus in which the muscles around the vagina contract and expand involuntarily, especially when the vagina is penetrated during sexual intercourse.

Anorgasmia in which a woman is unable to reach orgasm during sex is another symptom of female sexual dysfunction. Women experiencing sexual dysfunction may also experience inhibited sexual desires. These women may feel little or no interest in sexual activity. They may not have sexual fantasies or experience a significant reduction in sexual fantasies.


The causal factors may be physical, psychological, societal, or any combination thereof. The physical causes include medical conditions such as hormonal imbalances, which is the case for many women experiencing female sexual dysfunction during menopause. Physical conditions may render insufficient blood flow to the female reproductive system, and they may render the vagina dry, in turn making penetration and stimulation difficult. Vaginal dryness particularly afflicts women who are post-menopause, as it is linked to reduced levels of estrogen.

Patients with chronic kidney disease and liver disease are also at risk of sexual dysfunction. Neurological disorders, diabetes, cancer, and cardiovascular disease are all diseases that are associated with female sexual dysfunction. Sexually transmitted diseases may cause various physical and anatomical changes that impede sexual function. Certain prescription medications may cause sexual dysfunction as a side effect. Many antidepressants, for example, are known to cause sexual dysfunction.

Psychological trauma from past experiences such as rape is a major contributor to sexual problems in women. Other psychological causes include work-related stress, anxiety, marital conflict and depression.

Diagnosis & Tests

Diagnosis of female sexual dysfunction begins with a thorough physical examination of the patient. Depending on the symptoms, the physician may order a series of exams to be conducted on the patient with the intention of ruling out other disorders.

For instance, a pap smear test will be conducted to investigate any cellular changes in the cervix. This test may rule out the possibility of the presence of cancerous cells. Likewise, a pelvic examination evaluates the state of the female reproductive organs.

The doctor will inquire about any psychological factors involved in the patient's sexual dysfunction. They will inquire with the patient to determine if they have any inhibitions towards sex. They will also try to determine if the patient has a history of drug abuse, alcohol abuse, trauma, depression, anxiety, and other mental disorders.

Treatment & Therapy

The majority of sexual dysfunction cases can be treated by identifying its causes and using a diverse set of approaches. Treatments may include prescriptions such as flibanserin which is the first FDA-approved drug to address female sexual dysfunction. It is unclear why this drug works to increase libido, but it is a serotonin receptor agonist. It has negative interactions with alcohol as well as other severe side effects. It has been called the 'female viagra' in the press.

Hormonal imbalances may be dealt with through hormone replacement therapy such as estrogen replacement therapy and androgen replacement therapy. The latter involves taking synthetic testosterone though its efficacy is debatable. Hormone therapy may pose risks to one's heart and may also cause cancer.

Treatment may also involve sex therapy, a type of psychotherapy that can be conducted individually and in combination with a person's sexual partner (couples therapy). Recommendations to improve female sexual dysfunction include:

  • Employing techniques to promote relaxation and arousal before sex. These include verbalization of erotic and non-erotic fantasies, the use of pornography and erotica (audio, visual, and photographic stimuli). Couples are encouraged to increase communication and eliminate stress and anxiety. Sensual massage and warm baths are used to promote intimacy and relaxation.
  • Sexual education that discusses human anatomy and its changes over advancing years may assist some women with overcoming sex-related anxiety.
  • The use of sex toys may be encouraged.
  • In the case of weak sexual stimulation, doctors encourage couples to have spontaneous sex and eliminate the routine nature of sexual activity. Also, masturbation may be encouraged to promote the level of stimulation prior to sex. Here again, erotic materials may be employed.
  • There are vaginal lubricants which may be recommended to reduce friction thus alleviating pain. Heterosexual couples should also have sex in comfortable positions where the female can control penetration depth in order to reduce pain.

Prevention & Prophylaxis

A healthy lifestyle can help prevent female sexual dysfunction. Avoiding or getting help for alcohol abuse and drug abuse can promote overall physical and emotional wellness. Regular exercise and staying active can help women have energy and stamina to improve sexual function.

The brain also benefits from increased blood flow when exercising which can improve sexual function. Studies have shown that couples that exercise together may improve their sexual relationship.