Female Sexual Dysfunction

By Allen A. Farsaii, MD

Female Sexual Dysfunction (FSD) has been described in medical literature in different ways, however the definition and goal for treatment remains the same. There are four stages of female sexual function plateau, arousal, orgasm and resolution.
According to the World Health Organization, classification of FSD includes lack of sexual desire, failure of genital response and orgasmic dysfunction, vaginismus or dyspareunia (pain during intercourse). Any or all of these problems may be caused by physical or psychological factors. Consequently there are three different types of problems in three different stages of dysfunction 1. Desire, 2. Arousal, 3. Orgasm. Complete medical and sexual history is crucial in a physicians diagnosis.
Lack of desire in younger women could be temporary or prolonged. Loss of interest or lack of desire can trigger lack of orgasm or vaginismus. A long list of medications, (antidepressants, and depression itself, antihypertensive drugs, sedatives, tricyclic antidepressants, cancer medications, to name just a few) can create a lack of desire. It is clear that after menopause women have significantly lower desire. It is important that some women can still maintain their sexual function but at a slower pace. After menopause many factors play an important role in maintaining sexual function, such as pre-menopausal lifestyle, prior or present sex partner(s) and other psychosexual factors, and the patients general health condition. Lack of vaginal lubrication (due to lower estrogen and progesterone levels), diabetes, arthritis, kidney dysfunction and metabolic disease disturb sexual function in both pre- and post-menopausal women.
Problems with arousal may exist alone or in combination with the farother stages. Less vaginal blood circulation and, again, lack of lubrication due to low hormone levels due to lack of estrogen vaginal flora (causing higher pH), infection and decreased vaginal folds and even length, vaginal dryness, atrophy (to become smaller), pelvis surgery and other systemic diseases (cancer, MS) and medications, are just a few causing factors.
Most women are able to reach orgasm with stimulation, however up to 40% of women can not reach orgasm without clitoral stimulation. Nevertheless, a very small percentage of women can not get to orgasm even with stimulation. Postmenopausal women have lower genital contraction and even when orgasm occurs it may be painful. Psychological causes and specifically serotonin reuptake (SSRI) and almost all antidepressants can cause problems, although these patients need to take their antidepressants. Research regarding the use of oral sildenafil (Viagra) for this group of patients is ongoing and the results are promising. Nitric oxide has a significant role in both men and women. Other causes of lack of orgasm may be cardiovascular disease, hysterectomy, multiple sclerosis or spinal cord injury.