Female Sexual Dysfunction

Female Sexual Dysfunction (FSD) is a worldwide problem, afflicting approximately 40% of Malaysian women alone and there are few treatment options. FSD is more typical as women age and is a progressive condition. Only a small percentage of women seek medical attention. In a conservative society such as Malaysia, it is inherently even more difficult to address these issues with religious, cultural, and ethnic factors complicating matters. In comparison to the overwhelming research and treatment for erectile dysfunction in males, significantly less has been explored regarding FSD and treatment is primarily limited to psychological therapy.

FSD is defined by the World Health Organization as ‘the various ways in which a woman is unable to participate in a sexual relationship as she would wish’. There are several existing FSD definitions; persistent/recurring decrease in sexual desire or arousal, the difficulty/inability to achieve an orgasm, and/or the feeling of pain during sexual intercourse. FSD can be both short-term or lifelong.

Types of Female Sexual Dysfunction and their symptoms:

1. Hypoactive sexual desire disorder (low sexual desire): Most common of female sexual dysfunction involves a lack of sexual interest and willingness to be sexual.
2. Female sexual arousal disorder: Often desire for sex might be intact, but you have difficulty with arousal or are unable to become aroused or maintain arousal during sexual activity.
3. Anorgasmia (orgasmic disorder): Persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.
4. Sexual pain disorder: There is pain associated with sexual stimulation or vaginal contact.

Factors contributing to FSD can be divided into physical and psychological.

Physical causes of sexual dysfunction in women may include:

1. Gynecological conditions: Endometriosis, ovarian cysts, uterine fibroids, and vaginitis can all cause pain and make intercourse uncomfortable.

2. Hormonal changes: Perimenopause, menopause, pregnancy and undergoing hysterectomy/oophorectomy, can affect hormone levels. An imbalanced hormone leads to vaginal dryness or vaginal atrophy, which in turn leads to painful sex.

3. Underlying medical conditions: Diseases such as diabetes, arthritis, multiple sclerosis, and heart disease can affect your ability to enjoy sex.  These disorders may prevent blood flow to parts of the female reproductive system. Drug addiction or alcohol abuse may also prevent a healthy sexual experience.

4. Certain medications and treatments: Some medications affect sexual function. Antidepressants may reduce your sex drive or your ability to have an orgasm. Selective serotonin uptake inhibitors (SSRIs) are especially likely to cause sexual side effects. Chemotherapy and other cancer treatments can also affect hormone levels and cause problems.

Here are some of the psychological causes of sexual dysfunction in women:

1. Depression: Depression may lead to a lack of interest in sex. 

2. Stress: Studies show that stress can increase levels of the hormone cortisol. This increase may lower sex drive.

3. Past physical or sexual abuse: Trauma or abuse may cause anxiety and a fear of intimacy. These feelings can make it difficult to have sex

How is Female sexual dysfunction diagnosed: 

During your visit to the doctor, a detailed history would be taken. A thorough evaluation of physical and psychological factors would be assessed.

A physical exam involving pelvic exam and a pap smear can also rule out any gynecologic issues. In some cases, imaging tests to look for any abnormalities may also be necessary. Blood tests can help diagnose hormone imbalances. 

Treatment for Female sexual dysfunction: 

• Arousal techniques:  Consider making changes to your sexual routine. You may also try erotic materials. Good communication with your partner helps while you’re combatting FSD.
• Counseling and cognitive behavioral therapy: Talking with a mental health professional may help. You can work through emotional or psychological barriers to pleasurable sex. Lifestyle changes such as weight loss and smoking cessation have been shown to improve sexual function.
• Hormone/non-hormonal therapy: depending on your symptoms, your doctor might decide on some medications that can be administered vaginally, consumed orally or applied to your skin.
• Pain management: There are several approaches to reducing pain during intercourse. You can try different sexual positions, vaginal lubricants, and relaxation techniques before sex, or practice with dilators first till you’re comfortable.

How to prevent Female sexual dysfunction: 

There is no one fixed way to prevent this, however certain steps can be taken to promote overall health and well-being. This in turn leads to improved quality of your sex life.

• Avoiding drugs and too much alcohol.
• Eating a balanced diet.
• Exercising regularly.
• Maintaining a healthy body weight.
• Healthy communication with your partner
• Seeking help early if you have signs of low mood/depression/anxiety/poorly controlled stress