Female sexual dysfunction

Written by Oladapo Ashiru - Nigeria

Sex is often presented by the media as easy, good and spontaneous, suggesting that we should always be in the mood for it. If only sex were that simple!

The issues of intimacy are of great interest and concern to both men and women. Experts now recognise the interrelationship between sex, sexuality and level of health, vitality and function of their patients' lives. They conclude that sexual satisfaction is an indicator of overall health, with sexuality being an important part of medical histories.

The evaluation of patients is with a view to not only helping them with their presenting complaints, but to also look for opportunities to enhance and improve their sex life, which is paramount. Many patients, both male and female, are however uncomfortable going into details about this very personal area of their lives.

The overall attitude of secrecy, shame and uncertainty about the role of sexuality in overall health can be well summarised by a recent letter received by a physician. It reads:

"I am 52 years of age and so is my husband. It is about our sex life, it just seems like it's gone. Is that normal for our age or can we be low on certain vitamins? Is there something we can get to boost our sex drive? We always had a good sex life and now it is totally gone."

Participating in sexual activities is a good indicator, while loss of interest and reduction in sex is a very negative sign for a person's good health, overall vitality and longevity. From the above email, there is a general myth that sexual energy wanes and disappears with age.

Recent studies reveal that nearly 40 to 90 per cent of women of all ages report having sexual problems and women experience sexual difficulties at some point in their lives.

During menopause, 50 per cent women or even more may experience sexual dysfunction, in which case the sexual needs, patterns and performance may not be the same as they were when they were half their age.

What are female sexual problems?

There are a variety of sexual problems that women experience, either alone or with a partner. The term 'sex' is not limited to just intercourse, and can also refer to a variety of intimate sexual activities such as fondling, self stimulation or masturbation and oral sex. Female Sexual Dysfunction involves any problem that occurs in the course of sexual activity, including not being in the mood, trouble becoming aroused, vaginal dryness, difficulty having orgasms, pain related to sexual activities or during sex.

Sexual dysfunction

It is the persistent or recurrent lack of sexual thoughts and/or receptivity to sexual activity, which causes personal distress. It occurs in one or more of the stages of having sex; it occurs in both male and female.

It is important to recognise that FSD is far more common in patients with a history of sexual abuse or rape. Forty per cent of women who reported that they have been sexually abused had problems with FSD. It is not considered a sexual disorder unless you are distressed about it or it negatively affects your relationship with your partner. FSD occurs in women of all ages and it can be divided into four categories by doctors and sex therapists namely:

Low sexual desire: This is the most common type of FSD and accounts for 87.2 per cent of cases characterised by poor libido or lack of sex drive. Low sexual desire may result from endocrine failure and may be associated with psychological or emotional disorders. Sexual aversion disorder is a subcategory of LSD.

Sexual arousal disorder: In this situation, your desire for sex might be intact, but you're unable to become aroused or maintain arousal during sexual activity. It is the persistent or recurrent inability to reach or maintain sexual excitement, which causes personal distress. This disorder includes poor vaginal muscle relaxation and lubrication.

Orgasmic disorder: Presents with persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation. It accounts for 83.3 per cent of cases of FSD.

Sexual pain disorder: The vagina is painful after being sexually stimulated or touched. Subcategories include painful intercourse and vagina spasm. This may be caused by injuries during surgery and physical or psychological trauma involving the pelvis. It accounts for 71.7 per cent of FSD.

Not all sexual problems in women fit into these categories. With increased information about the complicated nature of female sexual response, a new view has emerged which focuses on the concept that female sexual response is a combination of complex interactions of many components, including the woman's physiology, emotions, experiences, beliefs, lifestyle and relationships.