Female Sexual Dysfunction (FSD)
|Definition of female sexual dysfunction:
Female sexual dysfunction is considered the collective term for the various disorders of the sexual process in women. Female sexual dysfunctions are currently classified as discrete individual disorders in one of the phases of the sexual response cycles – desire, arousal, orgasm, resolution / satisfaction, or pain related to sexual activity – however, it is seldom that one of these disorders occurs in isolation from another.
Lack or loss of sexual drive:
It is estimated that 30% of women with sexual dysfunction problems have no sex drive (the “biological” force which makes a person seek out or accept sex). Affected women have no need for sex (unless the wish to have a baby). New evidence indicates that lack of sex drive is likely to have biological or physical cause such as insufficient blood flow to the clitoris or vagina; neurological impairment (possible after pelvic or gynaecological surgery); low testosterone levels or may be a consequence of an organic disease such as raised blood pressure.
Inhibited sexual desire (ISD):
Reduced sexual desire is the most frequent complaint among women attending sex therapy clinics in the UK – affecting nearly 80% of women who seek help. Symptoms include: loss of sexual “spark”; little desire to initiate sex (although if stimulated sufficiently can still achieve orgasm); aversion to “sexual overtures”; pain on intercourse; emotional upset; inability to respond to stimulation or maintain lubrication. Possible causes can include; extreme tiredness, depression, use of antidepressants, psychological blocks, stress, general unhappiness in relationship.
Female sexual arousal disorder (FSAD):
Female sexual arousal disorder can occur on its own or in conjunction with inhibited sexual desire and lack of sexual drive disorders. It is defined as the persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate lubrication – swelling response of sexual excitement. According to new research, FSAD may be due to factors such as vascular and clitoral erectile insufficiency syndrome which means there is insufficient blood flow to the female sexual tissues (clitoris, vagina, urethra) to enable the necessary lubrication and engorgement for satisfactory sexual activity. Possible causes can include: physiological complications such as impaired blood flow or nerve damage to the sexual tissue, or it may be secondary to a disease or may be lack of adequate stimulation from a partner.
Female orgasmic disorder (FOD):
Female orgasmic disorder is defined as the persistent (or recurrent) delay in, or absence of, orgasm following a normal sexual excitement phase. Women exhibit wide variability in the type or intensity of stimulation that triggers orgasm. The diagnosis of FOD should be based on the clinician’s judgement that woman’s orgasmic capacity is less than would be reasonable for her age, sexual experience and the adequacy of sexual stimulation she receives. There is probably a significant psychological element in orgasmic disorders.
Female androgen deficiency syndrome (FADS):
Testosterone (the male sex hormone) is an androgen hormone, which is also secreted, in smaller amounts by the ovaries and adrenal glands in women. It is thought to be the hormone of desire because of its positive influence on the sex drive. As women age their levels of testosterone fall considerably (but not dramatically like oestrogen levels at menopause). Dr Susan Davies of the Jean Haile Research institute in Australia has discovered that many older women who complain of a lack of sexual drive are in fact suffering from androgen deficiency.
Possible causes of female sexual dysfunction:
“Female sexual desire has a strong psychological and emotional input than male desire”. C. Kalamis, “Women without sex”, published 1999.
1) Psychological problems:
The sexual circuitry (which orchestrates the sexual response) is strongly influenced by what goes on in the mind and in the emotions. Sexual arousal can be compared to an electrical circuit, which can be subject to breakdowns at many different junctions along the route to sexual fulfilment. Such breakpoints are:
Key psychological problems:
Growing up in a family with strong sexual taboos can lead to diminished sexuality, sexual dysfunction and problems with orgasm. This can lead to feelings of distress through the perception of being unable to please a partner resulting in a vicious circle of anxiety to decreased lubrication and pain on intercourse leading to avoidance of sex and eventual (in some cases) relationship breakdown. Depression (or drugs given for treatment of depression) may also play a part, along with a loss of self-confidence and self-esteem.
A UK study has found that 6% of women questioned about their sexual difficulties were depressed. Historically, women who have lost their self-confidence or self-esteem or suffer from depression may be unable to reach orgasm because something switches off before orgasm is reached – perhaps associated with a fear of letting go and losing control.
2) Possible physiological causes of FSD:
Apart from the considerable impact of psyche on female sexuality, there ate now believed to be a number of physical causes of FSD:
3) Possible risk factors for female sexual dysfunction:
Many of the following (except those that are female gender-specific) are risk factors for male (erectile) dysfunction too:
However, Dr Roy Levin of Sheffield University, UK, who’s work on the female sexual response spans 30 years, suggests that many women suffer sexually because they are simply not being stimulated sufficiently or effectively by their partners – due to:
Women consider that attraction, passion, trust and intimacy are more significant than their genital response. Some women find that specific problems can easily put them off sex and cause them to lose their desire for sex.
Diagnosis of female sexual dysfunction:
Only a small proportion of women come forward to have their sexual problems diagnosed and even fewer accept treatment. The first full population study of the extent and nature of sexual problems in the UK has reinforced the finding that 4 in 10 women are affected by sexual problems. Of 789 men and 979 women from 4 GP practises, the following findings were uncovered:
The nature of a woman’s FSD can be diagnosed by combining sexual and clinical history, a physical examination, laboratory tests (such as oestrogen, progesterone and testosterone levels; Doppler ultra sonography, vaginal photo-plethysmography or vaginal thermal clearance) and / or filling out a simple questionnaire.
However, because mood, environment, etc. have such a strong influence on female sexuality, these measuring devices are often not as accurate as they would be in a “real” sexual situation at home and some women self report lack of arousal when in fact the physiological status reports the opposite.
Treatment of female sexual dysfunction:
The problem of female sexual dysfunction is widespread, yet very little is being done for affected women, partly due to the fact that so few women seek help and perhaps, partly because they are unsure of where to go for help. Apart from GP, Genito-Urinary clinic, Sexual and Marriage therapists (who mostly take a psychological approach), there are few clinics offering specific sexual help for women from a medical perspective. Also, little attention is focused on the fact that a woman may be more prepared to talk to another woman about her sexual difficulties.
Possible treatments for female sexual dysfunction:
Counselling has an important role if there is a psychological or behavioural basis for the sexual dysfunction. It is also important where there are relationship difficulties. But medical intervention may be necessary if there is a physiological cause.
Diet for sexual health:
Diets high in fat and sugars have been found to lower levels of sex hormone binding globulin which controls how much oestrogen and testosterone circulate around the body. Eating food like grains, milk, eggs. Lean meat (chicken), fish, fruit, green vegetables and nuts will help boost sex hormone function. Adding foods which contain beneficial fatty acids (such as are found in mackerel, olive oil and evening primrose oil) will also improve sex hormone function. Fibre-rich foods for the health of bowel and circulatory systems and calcium-rich foods (spinach, figs) for bone health are particularly important for menopausal women. Coffee and tea, us of salt and cooking in animal fats should be kept to a minimum.
Natural food supplements for improving female sexual function:
There are a number of herbs, vitamins and minerals, which can be of benefit in improving female sexuality and dysfunction: