Female Sexual Dysfunction
Female sexual dysfunction is a medical term for ongoing sexual problems that upset you or your partner. Problems may involve sexual response, desire, orgasm or pain during sex.
Many people have sexual problems at some point. Some have them throughout their lives. Female sexual dysfunction can happen at any stage of life. It can happen only sometimes or all the time during sex.
Sexual response is complex. It involves how your body works, your feelings, things that happen in your life, your beliefs, your lifestyle and how you relate to your partner. A problem in any one of these areas can affect sexual desire, arousal or satisfaction. Treatment often involves more than one approach.
Symptoms vary depending on the type of sexual dysfunction. Symptoms may include:
- Low sexual desire. This most common of female sexual dysfunctions involves a lack of interest in sex and not wanting to have sex.
- Sexual arousal disorder. Even if you want sex, sometimes it may be hard to get or stay aroused during sex.
- Orgasmic disorder. You have ongoing trouble having an orgasm even with enough sexual arousal.
- Sexual pain disorder. You have pain when having sex.
Sexual dysfunction problems often start when hormones change. This might be after having a baby or during menopause. Major illness, such as cancer, diabetes or heart disease, also can add to sexual dysfunction.
Factors that add to sex problems include the following:
- Physical. Medical conditions can lead to sexual dysfunction. These may include cancer, diabetes, kidney failure, multiple sclerosis, heart disease and bladder problems. Certain medicines can decrease your sexual desire and make it harder for you to have an orgasm. These include some medicines to treat depression, high blood pressure, allergies and cancers.
Hormonal. Lower estrogen levels after menopause may lead to changes in your genital tissues and how you respond to sex. Lower estrogen leads to less blood flow to the pelvis. This can cause you to have less feeling in your genitals and to need more time to become aroused and reach orgasm.
The vaginal lining also becomes thinner and less stretchy. Not being sexually active can make this worse. These factors can lead to painful intercourse, called dyspareunia. Sexual desire also lessens when hormone levels drop.
Your body’s hormone levels shift after giving birth and during breastfeeding. This can lead to vaginal dryness and affect your desire for sex.
Psychological and social. Anxiety or depression that isn’t treated can cause sexual dysfunction or add to it. So can long-term stress, a history of sexual abuse, worries of pregnancy and the demands of having an infant.
Problems with your partner can affect your sex life. So can cultural and religious issues and problems with body image.
This is short-term treatment that targets a single episode (outbreak). It involves taking antiviral medication when you first notice signs of an outbreak, like skin tingling or itching. The sooner you take it, the better it works. Providers use episodic therapy for primary HSV infections as well as recurrences.
Episodic therapy can:
- Make symptoms less severe.
- Help pain go away faster.
- Help sores heal faster.
- Lower the amount of virus that sheds from your skin.
Treating a single outbreak does not affect future outbreaks. Episodic therapy won’t stop you from having future outbreaks or affect their severity. To do that, you need chronic suppressive therapy.
This is when you take antiviral medications long-term. Providers recommend this approach for people who have genital herpes and:
- Experience frequent or severe outbreaks.
- Are immunocompromised.
- Have multiple sexual partners or partners who don’t have genital herpes.
Providers also recommend chronic therapy for people who have severe oral herpes outbreaks and/or at least six outbreaks per year.
Specific medications your provider may prescribe include:
- Acyclovir.
- Valacyclovir.
- Famciclovir.
Providers typically use chronic suppressive therapy for people with genital HSV-2. They don’t recommend it often for genital HSV-1 because this type causes fewer outbreaks.
Chronic suppressive therapy can:
- Lower the number of outbreaks you experience by 70% to 80%.
- Make symptoms less severe.
- Reduce viral shedding when you don’t have symptoms. This may help protect sexual partners.
Factors that may increase your risk of sexual dysfunction:
- Depression, anxiety and other mental health conditions.
- Heart disease, diabetes, cancer.
- Conditions of the spine and brain, called neurological. Examples are spinal cord injury or multiple sclerosis.
- Gynecological conditions, including infections.
- Certain medicines, such as those taken for depression or high blood pressure.
- Emotional or psychological stress, especially stress in your relationship with your partner.
- A history of sexual abuse.
- Lack of privacy.
References
- Shifren JL. Overview of sexual dysfunction in females: Epidemiology, risk factors, and evaluation. https://www.uptodate.com/contents/search. Accessed April 9, 2024.
- AskMayoExpert. Sexual dysfunction in women. Mayo Clinic; 2023.
- American College of Obstetricians and Gynecologists. Clinical Practice Guideline No. 213: Female sexual dysfunction. Obstetrics & Gynecology. 2019; doi:10.1097/AOG.0000000000003324.
- Effective treatments for sexual problems. The North American Menopause Society. https://www.menopause.org/for-women/sexual-health-menopause-online/effective-treatments-for-sexual-problems. April 9, 2024.
- Shifren JL. Overview of sexual dysfunction in females: Management. https://www.uptodate.com/contents/search. Accessed April 9, 2024.
- FAQs: Your sexual health. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/your-sexual-health. Accessed April 9, 2024.
- Salari N, et al. The effects of smoking on female sexual dysfunction: A systematic review and meta-analysis. Archives of Women’s Mental Health. 2022; doi:10.1007/s00737-022-01281-1.