Female sexual response is a complex interplay of physiological, emotional and psychosocial states. Disturbance of any component can affect any phase of the sexual response cycle. About 40-45% of women may experience some form of sexual dysfunction in their lifetime.
FEMALE SEXUAL FUNCTION
Female sexual function is not easily determined, as there is no single response from women but rather a wide variety of what can be considered normal.
The recent understanding of FSD has evolved over time.
The first formal model of the human sexual cycle was developed by Masters and Johnson. It described a linear four-stage model of physiological responses to sexual stimulation, which are:
The sexual response in both men and women begin in the desire phase. Sexual desire is the mental state created by external and internal stimuli that induces a need or want to partake in sexual activity. It may be triggered by thoughts, words, sights, smells, or touch. Desire may be obvious at the onset or may build once the woman is aroused.
A balance between two chemicals in the brain (serotonin and dopamine) controls this phase. Activation of these chemicals subsequently initiates some signals which produce genital sexual responses, through the spinal cord and related reflex centre.
In arousal phase, there is excitement of sexual desire during or while anticipating a sexual activity. It also has a physical element—an increase in blood flow to the genital area. In females, the increased blood flow causes the clitoris and vaginal walls to swell (a process called engorgement). The increase in blood flow also causes vaginal secretions (which provide lubrication) to increase. Blood flow also may increase without the woman being aware of it and without her feeling aroused.
Plateau phase is the continuation of arousal phase. It is at this phase that the level of sexual excitement has been reached and maintained for some time before reaching orgasmic stage.
Orgasmic phase is the peak or climax of sexual excitement. Just before orgasm, muscle tone throughout the body increases. As orgasm begins, the muscles around the vagina contract (tighten) rhythmically. It is associated with increase in heart rate, respiratory rate and blood pressure. Women may have several orgasms.
Resolution is a sense of well-being and total muscular relaxation. Resolution usually follows orgasm. However, resolution sometimes occur slowly after highly arousing sexual activity without orgasm. Some females can respond to additional stimulation almost immediately after resolution.
In addition to the traditional sexual response cycle proposed by Masters and Johnson, a pathway based on intimacy has been described recently to characterize female sexual response. The new intimacy-based model incorporates the role of emotional intimacy as well as sexual stimuli in the female’s sexual response cycle.
In this model, there is a continuity of sexual response rather than a linear one, as described by Masters and Johnson, and the female can enter at any point in the sexual cycle .
For example, an emotionally neutral woman can become motivated for sexual activity by emotional intimacy, which then enables her to become responsive to sexual stimuli. In this model, once the woman is responsive to sexual stimuli, psychological and biologic factors determine her ability to become aroused and desirous of sexual stimulation (subjective arousal). Orgasm may or may not occur, and sexual satisfaction is not completely based on this event.
FEMALE SEXUAL DYSFUNCTION
The sexuality of a woman is a vital part of her being, from which she can derive confidence, pleasure, intimacy, and motherhood. Hence, if there’s a disruption in a woman’s sexual function, feelings of inadequacy and emotional distress may result.
Female sexual dysfunction is defined as any problem that may be encountered in the sexual response cycle that deviates from a woman’s normal range of functioning. The peak age group for FSD is 51-59 years old. However, It can occur in women of all ages.
CRITERIA FOR DIAGNOSING FEMALE SEXUAL DYSFUNCTION
Before a woman can be diagnosed of FSD, symptoms must cause distress and must occur at least 75% of the time over a 6 months duration. If both criteria are not met, it’s merely a sexually difficulty.
CLASSIFFICATIONS OF FSD
FSD may be classified as
- Primary or Secondary: It is primary if a woman has never been able to achieve an adequate sexual response. It is considered secondary if a woman at a time had adequate sexual function, but then reports inadequate or absent sexual function in all or specific sexual states.
- Generalised or Situational: It is generalised if it occur with all partners while situational if with a particular partner.
- Mild/Moderate/Severe depending on the severity of distress.
CATEGORIES OF FEMALE SEXUAL DYSFUNCTION
The Diagnostic and Statistical Manual of Mental Disorders, now in its fourth edition (DSM-IV), categorizes sexual dysfunctions into four major categories: disorders of desire, arousal, orgasm, and pain. More importantly, the DSM-IV incorporates psychological factors into its analysis of dysfunction.
Sexual interest or desire disorder
The most common FSD. It is characterized as a lack or absence of desire for sexual activity. Any factors can contribute to a lack of desire, including hormonal changes, medical conditions and treatments (for example, cancer and chemotherapy), pregnancy, depression, stress, and fatigue.
Boredom with regular sexual routines also may contribute to a lack of enthusiasm for sexual activity, as can lifestyle factors, such as careers and the care of children.
Sexual arousal disorder
It is characterized by the lack or absence of desire for sexual activity with sexual stimulations that normally induce sexual arousal, or the disability to maintain sexual responses during sexual arousal. It causes reduced genital sensation, and decreased vaginal smooth muscle relaxation and lubrication. Sexual arousal disorder probably results from the side effect of medications, pelvic diseases, neural disorders, or peripheral vascular problems.
It refers to the inability to reach orgasm after adequate sexual arousal and stimulation. Orgasmic disorder also causes personal distress. This condition is referred to Anorgasmia.
It can be caused by a woman’s sexual inexperience, lack of knowledge, and psychological factors such as anxiety, abuse, or a past sexual abuse or trauma. Other factors contributing to anorgasmia include insufficient stimulation, certain medications, chronic diseases, neural disorders or spinal cord injuries
Sexual pain disorder
Sexual pain disorder refers to pain in the pelvis or vagina during any stage of normal sexual stage, including desire, arousal, or orgasm.The subcategories of sexual pain disorder include;
- Dyspareunia: is characterized by pain in the vagina during or after intercourse. it may occur as a result of an underlying medical condition such as vestibulitis, vaginal atrophy, or infection, or it may be psychological in origin.
- Vaginismus: characterized by involuntary contraction of the vagina-related musculature, which results in a painful penetration. It may occur in women who fear that penetration will be painful and also may stem from a sexual fear or from a previous injurious or painful experience.
WHAT ARE THE CAUSES OF FEMALE SEXUAL DYSFUNCTION?
The causes of FSD can be classified into;
Chronic medical conditions, including cancer, kidney failure, multiple sclerosis, heart disease and overactive bladder, can lead to sexual dysfunction. Certain medications, including some antidepressants, anti-hypertensives, antihistamines and chemotherapy drugs, can decrease sexual desire and the body’s ability to experience orgasm.
Lower estrogen levels after menopause may lead to changes in the genital tissues and sexual responsiveness. A decrease in estrogen leads to decreased blood flow to the pelvic region, which can result in less genital sensation, as well as needing more time to build arousal and reach orgasm.The vaginal lining also becomes thinner and less elastic, particularly if a woman is not sexually active. These factors can lead to painful intercourse (dyspareunia). Sexual desire also decreases when hormonal levels decrease.
The body’s hormone levels also shift after giving birth and during breast-feeding, which can lead to vaginal dryness and can affect your desire to have sex.
Psychological and social
Anxiety and depressive disorders can cause or contribute to sexual dysfunction, as can long-term stress and a history of sexual abuse. The worries of pregnancy and demands of being a new mother may have similar effects.
Long-standing conflicts with a partner — about sex or other aspects of the relationship — can diminish sexual responsiveness as well. Cultural and religious issues and problems with body image also can contribute.
WHAT FACTORS INCREASE THE RISK FOR FSD?
- Chronic medical conditions, such as diabetes, hypertension, overactive bladder, multiple sclerosis, spinal cord injury, and major depressive disorder, can contribute to female sexual dysfunction.
- Gynaecologic and obstetric conditions, such as endometriosis, fibroids, infections, various prolapses, non–nerve sparing hysterectomy, and previous episiotomy or operative delivery are also associated with sexual dysfunction.
- Medications such as anti-adrenergic receptor blockers, dopamine, anti-cholinergics and oral contraceptives.
- Other non-physical risk factors include tobacco, alcohol, and drug use, obesity, poverty, education level, negative past sexual experiences, and substandard relationships.
- Environment and choice of partner alone can be major factors in female sexual functioning and dysfunction.
HOW IS IT DIAGNOSED?
This begins with a physical examination and a thorough evaluation of symptoms. A pelvic exam to evaluate the health of the reproductive organs and pap smear to detect changes in the cells of the cervix.
Evaluation of attitudes regarding sex as well as other contributing factors which would be derived from history taking will help detect the underlying cause of the problem. A woman’s age will factor into the diagnosis as well. The doctor may also order lab tests to ascertain physical causes of sexual dysfunction.
CAN FSD BE TREATED?
Female sexual dysfunction requires a tripartite effort between the woman, the doctor and the therapsist depending on the underlying cause. Treatment strategies include;
- Patient education about her anatomy, and normal changes associated with aging, menopause, pregnancy as well as sexual behaviours may help a woman overcome her anxieties about sexual function and performance.
- Enhancing stimulation possibly through the use of erotic materials, masturbation, modification of sexual routines in order to get to know what’s good for you, it could include trying different positions, having sex at different times of the day as well as in new places.
- Use of non-distracting techniques: the purpose of this is to relieve anxiety, erotic or non-erotic materials could be employed, this helps to relax you and create some form distractions, exercises most preferably contacting and relaxing pelvic muscles could be useful.
- Non-sexual behaviours should also be utilized to enhance the sexual activity, a sensual massage could help to feel comfortable around your partner as well as communicate better.
- Tackling the pain: now, if sexual dysfunction is as a result of pain, sometimes changing sexual positions may help, use of lubricants, relaxation before intercourse; a warm bath, meditation. Also avoiding deep thrusts and the use of non-steroidal anti-inflammatory drugs [NSAIDS] prior to intercourse to minimize pain
IS THERE CURE FOR FEMALE SEXUAL DYSFUNCTION?
The outcome of the treatment depends almost entirely on whether the underlying cause can be resolved. A psychological situation should be successfully resolved with counselling and methods to improve communication between partners. Now, if a combination of factors, contribute to the dysfunction, all of them have to be addressed to improve the outcome.
Sexual problems are part of the process of life as nearly every woman would experience it. It is advisable you speak with your doctor regularly as help is available. The effects of this cannot be over emphasized as it is definitely detrimental to relationships. You don’t have to suffer and bear the pain all alone in silence, you don’t have to forego the pleasure of sex, remember, communication is key.
F.O. Adagbonyin, MB.BS in view, certified content creator at Medblog180 and MedicWord, licensed google writer and contributing writer at WikiMedia Foundation.
R. M. Ogosi, MB.BS in view, licensed google writer and contributing writer at WikiMedia Foundation.