Condition: Female Sexual Dysfunction
Brief Overview: According to UpToDate, “Female sexual dysfunction refers to a sexual problem associated with personal distress. It takes different forms, including lack of sexual desire, impaired arousal, inability to achieve orgasm, or pain with sexual activity [6]. Sexual dysfunction may be a problem since the start of sexual activity or may be acquired later in life after a period of normal sexual functioning.”
Prevalence: According to UpToDate, “Sexual concerns are reported by approximately 40 percent of females worldwide.”
Etiology: According to UpToDate, “The etiology of sexual dysfunction is often multifactorial and may include psychological problems such as depression or anxiety, conflict within the relationship, fatigue, stress, lack of privacy, issues relating to prior physical or sexual abuse, medications, or physical problems that make sexual activity uncomfortable, such as endometriosis or genitourinary syndrome of menopause (GSM).”
Risk Factors:
- Relationship factors
- History of physical, sexual abuse
- Stress, fatigue
- Menopause, postmenopausal, hormonal changes, genitourinary syndrome of menopause (GSM)
- Depression, anxiety, psychosis
- Pelvic organ prolapse
- Incontinence
- Endometriosis
- Uterine fibroids
- Endocrine conditions – hyperthyroidism, diabetes
- HTN
- MS, Parkinson’s, epilepsy
- Poor body image
- CKD, dialysis
- Nicotine use
- Certain medications
Commonly Associated Conditions:
- Depression and Anxiety disorders
- Diabetes mellitus
- Cardiovascular disease
- Hypoactive sexual desire disorder (HSDD)
- Genitourinary syndrome of menopause (vaginal atrophy)
- Pelvic floor dysfunction or chronic pelvic pain
- Dyspareunia and Vaginismus
- Endometriosis
Common Medications:
- Bupropion
- Sildenafil
- Vaginal estrogen, DHEA
- Ospemifene
- Systemic estrogen
- Testosterone
- Flibanserin
- Bremelanotide
Common Labs, Imaging, and Tests:
- Pelvic exam
- No additional testing needed unless clinically indicated based on history/exam
Common Symptoms:
- Low sexual desire or loss of interest
- Difficulty with arousal or vaginal lubrication
- Pain with intercourse (dyspareunia)
- Difficulty achieving orgasm
- Decreased genital sensation
- Relationship strain or distress due to sexual issues
- Decreased self-esteem or body image satisfaction
Common Treatments:
- Therapy – including couples therapy, sex therapy
- Treatment for any underlying conditions, including sleep disturbances
- Stress reduction measures
- Pelvic floor physical therapy
- Vaginal moisturizers, lubricants
Physical Findings:
- Vaginal atrophy (pale, thin tissue, loss of rugae)
- Decreased vaginal lubrication
- Pelvic floor tenderness or hypertonicity
- Pain or discomfort with speculum exam
- Otherwise, normal genital exam in many cases
Potential Complications and Contraindications:
- Relationship distress, depression, reduced quality of life
- Avoid hormonal therapy in patients with active breast cancer, thromboembolic disease, unexplained vaginal bleeding, etc.
- Side effects from some medications (like flibanserin, bremelanotide)
- Potential for worsening pain or anxiety if psychological factors not addressed
General Health and Lifestyle Guidance:
- Encourage open communication and shared decision-making with partner.
- Regular exercise (as tolerated, and approved by healthcare provider) and stress management can improve libido and energy.
- Work with your healthcare provider to manage any chronic conditions (diabetes, thyroid, depression) to reduce impact on sexual health.
- Maintain vaginal health with lubricants or localized estrogen when appropriate/as directed by your healthcare provider.
- Prioritize self-care, sleep, and body image support.
Suggested Questions to Ask Patients:
- Have you noticed changes in your sexual interest or satisfaction?
- Is pain, dryness, or discomfort a concern during intimacy?
- Are you currently taking any antidepressants, hormones, or new medications?
- How are these symptoms affecting your relationship or emotional well-being?
- Are there any other symptoms such as hot flashes, mood changes, or fatigue?
- Would you be open to a referral for sexual health or pelvic floor therapy?
Suggested Talking Points:
- Female sexual health is an important part of overall wellness.
- These symptoms are common and often improve with a combination of medical and lifestyle treatments.
- There are medications and therapies that can help restore comfort and desire.
- Open communication with your partner and care team can make a big difference.
- It’s important to treat both physical and emotional contributors together.
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
Sources:
- https://www.uptodate.com/contents/overview-of-sexual-dysfunction-in-females-epidemiology-risk-factors-and-evaluation?search=female%20sexual%20dysfunction&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
- https://www.uptodate.com/contents/overview-of-sexual-dysfunction-in-females-management?search=female%20sexual%20dysfunction&topicRef=5424&source=see_link