Sexual dysfunction in women

Dr Brigid Monda

Men are not the only ones who experience challenges in the bedroom — women too. They could suffer from Female Sexual Dysfunction (FSD), which includes loss of libido, a diminishing sex drive or even pain during intercourse, thus disrupting her sex life.

FSD is a very common medical condition that occurs mainly among women between the ages of 25 to 50. But due to cultural, religious and social factors that view sex a taboo topic and where many women are socialised to believe that sex is not something they should enjoy, many still find it difficult to discuss. Many sexual problems, therefore, go untreated for even a lifetime.

There are different types of FSD, which could occur, alone or together:

Disorders of desire: Lack of sexual desire is the most commonly experienced challenge in women. It is caused by several factors which include boredom due to a repeated sex routine, a bad relationship or experience like rape or stress due to a demanding job and family. Nothing kills the libido faster than fatigue.

Arousal disorders: It could result from inadequate stimulation and is more prevalent in older women who require more stimulation to reach a similar level of arousal that they easily attained at a younger age. Anxiety too may inhibit arousal. Estrogen and Testosterone, the male sex hormone produced in small quantities in women by the ovary also drops significantly after menopause causing a decline in genital sensation and libido.

Orgasmic disorders: The inability to achieve orgasm can stem from negative feelings about sex due to childhood sexual abuse or rape, anger, depression, and use of drugs or alcohol.

Focusing too much on technique and having an orgasm and not mutual pleasure diminishes sexual excitement because it creates anxiety and distractions.

Sexual pain disorders: They include vaginismus or dyspareunia. Vaginismus is the involuntary spasm of the vaginal muscles that makes penetration painful and can be caused by a woman’s fear of losing control, fear of pregnancy, past rape or sexual abuse, painful scars in the vaginal opening from injury during childbirth, surgery or circumcision; irritation from douches, spermicides or latex condoms and pelvic infections. Dyspareunia or ‘pain during intercourse’ may be caused by poor vaginal lubrication, infections, vaginal irritation due to the use of spermicides, douches or latex condoms and pelvic infections.

Contrary to popular belief that FSD is psychological in nature — something in her head — it results from psychological, physical and relationship problems, which are intertwined and are influenced by one’s health, environment and the behaviour of our partner and others.

The common causes of FSD are:

Physical causes: Fatigue due to stress, physical work or even sleep deficit or hot flashes; muscle or joint pain, pain with intercourse and urinary incontinence may interfere with sexual relations.

Pregnancy: Sexual activity does not have to change during pregnancy because intercourse does not harm the baby unless other conditions are present. But a decrease in sexual desire often prolonged by breastfeeding may occur immediately after birth. A combination of fatigue, fluctuating hormone levels and an episiotomy that is still healing may prevent couples from having sex after birth.

Drugs: Antidepressant medicines could decrease sexual desire above and beyond the effect that the depression itself has. Pain relievers like opiate block testosterone synthesis and decrease sexual response.

Menopause: Declining levels of testosterone, estrogen and progesterone cause a gradual loss of desire; difficulty getting aroused and painful intercourse because the vagina is dry due to a lack of lubrication and the tissues are thin and friable making sexual activity uncomfortable. Hot flushes can make women feel unattractive and many experience mood swings that leave them depressed and tearful.

Cancer: Loss of the uterus or breast due to disease removes physical symbols of femininity that may result in feelings of decreased sexuality for the woman. The treatment on the other hand can be painful, sap the woman’s energy as well as cause premature menopause. She may struggle with fears of death, disfigurement, or the partner’s rejection.

Chronic illness: Terminal diseases like diabetes can have a major impact on a woman’s self-image and her sexuality. Diabetes can cause a reduction in lubrication and blood flow to the genitals. Some medication can also affect her libido.

Male factor: If a male partner is having sexual difficulties like erectile dysfunction or is being unfaithful.

Psychosocial factors: Issues like self-esteem, body image, and her relationship with her partner all have an impact on sexual arousal. Anger with one’s sexual partner, anxiety, guilt like a widow with a new partner, sexual, verbal or physical abuse, sexual inexperience, financial, family or job problems, family illness or death, depression and drugs used to treat it can also cause FSD and just plain boredom with the same sexual script.

Remember that humans are the only primates whose sexual desire is not solely meant for reproduction but for pleasure as well. So women should not miss out on what nature has gifted us with.