The struggle is REAL!
Female Sexual Dysfunction, or FSD, is becoming one of the most highly studied areas of medicine in recent years. Women are driving a shift in research and clinical trials toward FSD. The latest research shows that female sexual dysfunction usually involves multiple conditions, rather than a single physical event. Conditions such as stress, depression, low self-esteem, painful sex, medication that lowers desire, and relationship issues can contribute to a woman experiencing FSD. Treatment may involve multiple options that are individualized to the patient, including medicine, physical therapy, sexual health counseling, and/or a conversation with the female’s partner. Regardless, FSD is a concern for women of all ages. Most often, women are “embarrassed” or “too proud” to talk about their sexual shortcomings or even their sex life in general. They feel that there is no hope for them or nothing out there to fix their sexual problems. If you’ve even felt like your sex life isn’t where you want it to be, or that you have physical or emotional problems preventing you from actively wanting to engage in sex, there is news for you… YOU ARE NOT ALONE! A study from the Journal of the American Medical Association in 1999 found that of an analysis of 1749 women’s responses, 43% were reported to have some form of sexual dysfunction. Categories included lack of sexual desire, difficulty in becoming aroused, inability to achieve orgasm, anxiety about sexual performance, reaching orgasm too rapidly, pain during intercourse, or failure to derive pleasure from sex.

There are varying types of sexual dysfunction!
Typically FSD arises as a result of hormone fluctuation during pregnancy, menopause, or surgical menopause, but can affect any age. FSD may arise at any stage of life, be lifelong, or be acquired later in life. The American Foundation for Urologic Disease proposed several different definitions regarding Female Sexual Dysfunction in March of 2000. These definitions encompass both physiologic and psychologic symptoms which may be experienced by women and warrant an FSD diagnosis.

Definitions of female sexual dysfunction (FSD)
- Hypoactive sexual desire disorder†: Chronic lack of interest in sexual activity
- Sexual aversion disorder†: Persistent or recurrent phobic avoidance of sexual contact with a partner
- Sexual arousal disorder†: Persistent or recurrent inability to attain or maintain sexual excitement
- Orgasmic disorder†: Chronic difficulty in attaining (or inability to attain) orgasm following sufficient arousal
- Dyspareunia: Pain during intercourse
- Vaginismus: Involuntary vaginal spasms that interfere with penetration
- Noncoital sexual pain: Genital pain following stimulation during foreplay
- † These must cause the woman distress to qualify as FSD.

It’s OK to talk about it!
It’s not the first thing you gush to your OBGYN when you pay them a visit. It’s often hard to explain it to a friend or partner. But talking about your sexual dysfunction is one of the first steps toward finding the cause and treatment for this common disorder, that so often is swept under the rug.

Your current or previous ailments can contribute to your sexual function!
You should always discuss any current or prior medical conditions and medication changes with your doctor, but few women contribute these to forms of sexual dysfunction. The reality is, as our bodies change with time or surgical procedures (i.e hysterectomy or oophorectomy), our sex lives may also be affected. Several conditions, procedures, or medications can make an unsettling environment for sex:

- Estrogen insufficiency: Reduced vaginal lubrication
- Testosterone insufficiency: Reduced libido
- Diabetes: Reduced vaginal lubrication, vaginal infections
- Thyroid, adrenal, pituitary disorders: Reduced vaginal lubrication
- Sickle cell anemia: Decreased arousal and orgasm
- Spinal cord damage, stroke, Parkinson's disease, multiple sclerosis: Decreased vaginal lubrication, arousal, orgasm
- Vaginitis, pelvic inflammatory disease, endometriosis: Vaginismus, dyspareunia
- Prolapsed uterus or uterine fibroids: Decreased arousal
- Kidney failure requiring dialysis: Decreased arousal and desire due to hormone imbalance
- Arthritis: Chronic pain that limits motion
- Sjögren's syndrome: Decreased lubrication
- Procedure: Effect(s)
- Oophorectomy: Decreased estrogen and lubrication
- Episiotomy: Tightness of vaginal opening
- Mastectomy, colostomy: Loss of self-esteem and sources of stimulation; fear of discomfort
- Drugs: Effect(s)
- Antihypertensives (diuretics, beta blockers, calcium-channel blockers, anti-adrenergics): Reduced libido, difficulty reaching orgasm
- Anticholinergics (propantheline, methantheline): Decreased lubrication
- Barbiturates: Various problems at high doses
- Benzodiazepines (diazepam, alprazolam): Difficulty reaching orgasm
- Antidepressants: Difficulty reaching orgasm
- Cancer chemotherapy (cyclophosphamide, anti-estrogens): Vaginal dryness, reduced libido, difficulty reaching orgasm
- Opiates (morphine, codeine, methadone): Reduced libido

Help is on the way!
We are all aware of the help available to men, including treatments for erectile dysfunction and low testosterone levels. Much to our dismay, family physicians, gynecologists, therapists, and pharmacists are trained in these very fields of study. It is not uncommon for your physicians to have several solutions and treatments for sexual dysfunction – all you have to do is ask!

Treatments for female sexual dysfunction include a combination of nonmedical and medical approaches designed to address your mental and physical well-being.
Non-medical approaches include:
- Practicing open and honest communication with your partner about your sexual needs, desires, and dislikes
- Using a lubricant and/or taking a warm bath before sex
- Having sex in a different position (you may do better on top)
- Lifestyle changes such as avoiding excessive alcohol consumption, getting more exercise, and quitting smoking
- Talking with a counselor or therapist who specializes in sexual and/or relationship problems
- Learning and practicing pelvic floor exercises to help strengthen the muscles of your pelvic floor
- Various treatments for pelvic pain if such pain is contributing to your problem
Medical approaches include:
- Estrogen therapy
- Testosterone therapy (this is controversial)
- Treatment for depression or anxiety
- Treatment for any medical condition that may be contributing to your sexual dysfunction
- Changing a medication that may be causing the problem

For more information about Female Sexual Dysfunction and how you can get help, visit the following websites:
- International Society for the Study of Women’s Sexual Health - http://www.isswsh.org
- International Society for the Study of Vulvovaginal Disease - https://www.issvd.org
- International Pelvic Pain Society - http://pelvicpain.org
- International Society for Sexual Medicine - http://www.issm.info

References:
- Laumann EO1, Paik A1, Rosen RC1. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999 Feb 10;281(6):537-44.
- Basson R, et al. "Report of the International Consensus Development Conference on Female Sexual Dysfunction: Definitions and Classifications," Journal of Urology (March 2000), 163:888–895.
- Carlson K, et al. Harvard Guide to Women's Health; Lightner D. Mayo Clinic Proceedings, 2002 77: 698–702