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Feature Article | Feb 24, 2018

Female Sexual Dysfunction

Female Sexual Dysfunction

Sexual dysfunction affects 40% of females.
There are 3 main forms of Female sexual dysfunction(FSD) that affect adult females, mainly:

a.) Sexual interest and arousal disorders.
b.) Disorders of Orgasm
c.) Painful sexual intercourse.
SEXUAL INTEREST & AROUSAL DISORDERS include:

Lack of interest in sex
Lack of sexual thoughts and sexual fantasies.
Reduced initiation of sexual activity
Decreased responsiveness to a partner's initiation attempt.

Decreased response to sexual cues
Reduced excitement or pleasure during sexual activity

Decreased sensation during sexual activity
DISORDERS IN ORGASM
There is either persistence or recurrence of: absence, delay, or decreased intensity of orgasm, after sufficient sexual stimulation and arousal.

PAINFUL INTERCOURSE
Painful sex may be associated with irritative lesions in the vagina mucosa, inadequate vaginal lubrication, tense muscle, pelvis infections.

Fear of pain or anxiety about pain in anticipation, or during penetration, often leads to difficulty in vaginal penetration. Women may tense and tighten the pelvic floor muscle, during attempted penetration.

Painful sexual experiences do not enhance emotional intimacy. Women may become resentful, feel confused and used. Their mental processing of any remaining sexual stimulation is largely affected by the expected negative outcome.

PATHOPHYSIOLOGY OF FSD
Female sexual dysfunction has both psychological and biological components.

Sexual arousal begins in the brain. Electrical signals are then transmitted through the autonomic nervous systems, to the genitals.

Nitric oxide mediates clitoral and labial engorgement.

Vasoactive intestinal polypeptides increase vaginal blood flow, lubrication and secretions.

Vaginal smooth muscle relaxation allows for lengthening and dilatation of vagina

As clitoris is stimulated, its length and diameter increase, and engorgement, occurs.

The phases of a normal sexual cycle include the following:

A need for Emotional intimacy, makes women yield to sexual arousals and subsequent desire for sex.

A sexually neutral person may become sexually aroused after being sexually stimulated.

Sex arousal brings desire for sex.
Once sexual desire is accessed, receptivity to sexual stimuli increases, and a mental processing of these sexual stimulation, leads to further and more intense arousals.

Emotional and physical satisfaction may occur at sexual intercourse, which leads to emotional intimacy

Sexual pleasure and satisfaction are not dependent on achieving orgasm in many women.

Some women, however, may need to experience a number of separate orgasms, to be satisfied.

Many a time, getting physical and experiencing arousal, may bring about the desire for sex.

Achieving emotional intimacy makes women willing to be sexually aroused.

When emotional or physical satisfaction doesn't occur, most women get more distressed about their apparent low libido levels and by the pain on attempting intercourse.

FACTORS LEADING TO FEMALE SEXUAL DYSFUNCTION

BIOLOGIC FACTORS
Reduced Serotonin and norepinephrine levels in the brainstem, affect nerves stimulation of the genitalia. Depression is a common occurrence in Female with sexual dysfunction, due to low serotonin levels

A lack of androgen and thyroid hormones is also common.

Testosterone production is lower in menopause and can lead to decreased libido

Vaginal infection, and other pelvis infections
Insufficient Vaginal lubrication
Anatomical problems in the vagina and genitals, example: fibroids, episiotomy scars.

Medical illnesses like diabetes, heart diseases, circulation problems

PSYCHOLOGICAL FACTORS
Psychological factors block the autonomic signals to the genitals preventing affected persons from responding to sexual arousal.

Marital dissatisfaction
Most women become emotionally hurt by cheating spouses

Having dispute or being annoyed with spouse
Lack of peace at home
Socioeconomic stressors
Recall of previous negative vaginal sex experience
MANAGEMENT OF FEMALE SEXUAL DYSFUNCTION
It is always prudent to alert your gynecologist if you (or your partner) observe this disorder. The physician may evaluate to identify what may be biologically wrong and institute measures to correct the disorders.

Decreased Sex drive and Desire.
There are no specific medications for this disorder.

Aerobic exercise elevates Dopamine, Serotonin and Norepinephrine levels in the brain. Regular Exercise may improve depression and increase libido.

Lifestyle issues: finances, careers, family demands may greatly contribute to the problem. Counseling (individuals and couples) and lifestyle modifications help.

Hormonal replacement therapy
Vaginal estrogens may be used for vaginal dryness and discomfort with intercourse, to improve sexual satisfaction.

Estradiol, may benefit perimenopausal women by improving mood, libido, and increasing sensitivity of clitoris.

After appropriate counseling, Transdermal testosterone ointments or Low dose testosterone may be started to improve libido, especially in post menopause women.

Disorders of orgasm.
Female orgasm is not necessary for physical and emotional satisfaction during sex.

Sex therapy, when available, may be beneficial.
Painful Sex
For painful intercourse, related to history of sex abuse and trauma, sex therapy may benefit women with tensed and tightened pelvis floor.

Lubricants, vaginal estrogens, moist heat applied to the area, and NSAIDs like ibuprofen, may help with pain relief.

Alex Sarkodie MD
Alex Sarkodie MD, © 2018

Alex Sarkodie,MBChB has over 30 years experience in the field of Medicine

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