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Physical Causes of Female Sexual Dysfunction
There are any number of physical reasons why women might suffer from sexual dysfunction, ranging from the effects of certain drugs to age-related changes. In this section, we'll cover the physical causes of female sexual dysfunction.Hormones
Hormones are usually at the top of the list when it comes to tracking any changes, good or bad, in the human body. In women, estrogen and progesterone, which are produced in the ovaries, play enormously important and diverse roles, depending largely on age. Until a woman is in her forties, these hormones, as well as testosterone and other androgens, are operating more or less at full blast.
Testosterone fuels the sex drive, (yes, in women, too!) and estrogen keeps the vaginal environment moist. (However, vaginal dryness is still possible around the time of the woman's period or if she's taking certain oral contraceptives. In those cases, a water-based lubricant, such as K-Y Jelly, can help.)
Alternatively, an oral contraceptive with a high ratio of estrogen to progestin (a component of progesterone) may be the answer. Women who use triphasic pills, which contain variable combinations of estrogen and progestin, report more interest in sex and greater arousal. This may be because triphasics better mimic natural hormonal fluctuations.
Erratic estrogen output can wreak havoc on a woman's sex life. Ovulation becomes a very chancy occurrence, and many couples have been surprised by pregnancy. This uncertainty makes some women nervous about sex even if contraception is used.
As menopause gets closer, hormone levels begin to drop. Eventually the ovaries stop making estrogen and progesterone, and the vaginal wall becomes drier and less elastic, making intercourse painful. Hormone replacement therapy, either systemic (affecting the entire body) or topical (a cream applied to the vagina) can ease intercourse.
Drugs
In addition to hormonal contraceptives, a surprising number of drugs can interfere with sexual functioning. These include:
- Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) and Paxil (paroxetine), which can alter brain chemicals that affect sexual desire and response; they also can cause fatigue and nausea.
- Antibiotics, which can cause yeast infections, making intercourse uncomfortable.
- Antihistamines, which dry mucous membranes (including those of the vagina).
- Heart and hypertension medicines, which cause sexual dysfunction in as many as 25 percent of women taking them. In one study, women with unimpaired sexual function who were given clonidine and prazosin (antihypertensive medicines) were less likely to desire sex than those given a placebo.
- Tranquilizers, which can lower libido and delay or prevent orgasm.
- Diet aids, sleep aids, and other over-the-counter drugs, which can cause drowsiness, reduce sexual desire, and impair function.
Infections, such as urinary tract, rectal, and vaginal infections, and sexually transmitted diseases (for example, human papilloma virus, which causes genital warts) can cause pain during intercourse.
Impaired Blood Vessels
The study by Dr. Goldstein mentioned on the previous page suggests sexual dysfunction in women may be traced to vascular disease, specifically, decreased blood flow in vessels leading to sex organs. This would be similar to a leading cause of erectile dysfunction in men. Dr. Goldstein describes sexual dysfunction as, essentially, a "heart attack" of the vagina, clitoris, or penis. However, this field of study is very new, and not everyone agrees with Dr. Goldstein's theory.
Fatigue
Being tired is a real sex-buster. Sex therapist Domeena Renshaw recommends an unusual plan to tired women: Pick a night and set your alarm to ring 90 minutes after you go to bed. That's when your first sexual sleep cycle begins, she says, so you should be at peak arousal. Get up, shower together, and make love.
The shower refreshes you and the lovemaking relaxes you for getting back to sleep, plus you're getting some much-needed sexual time with your partner. Should your partner have ED problems, you can time this activity with the use of a drug like Viagra.
Illness or Injury
Organic diseases, such as disorders of the adrenal, pituitary, and thyroid glands (the regulators of hormones), can alter your attitude toward sex. Interestingly, oxytocin, which is secreted by the pituitary gland, has been linked in animals (not humans, yet) to the contractions of the uterus during orgasm. Oxytocin is better known as the substance given to pregnant women to induce contractions.
Chemotherapy
Side effects of chemotherapy, such as fatigue and nausea, can lower libido in cancer patients, who also may feel unattractive because of breast surgery or ostomies, for instance. Surgery for cancers of the ovary, bladder, rectum, and uterus can induce menopause, as can chemotherapy for breast cancer.
 Not surprisingly, chemotherapy can have an adverse effect on how a woman functions sexually. |
Hysterectomy can have completely opposite effects on sexual function: Half of 104 women in one study reported improvement after subtotal hysterectomy; 21 percent reported deterioration. Those who felt better were more likely to have had satisfying sex lives before the surgery.
Hysterectomy should not affect sexual desire or function if the ovaries (which produce hormones) are still intact, and hormone replacement therapy can make up for missing ovaries. Regardless, the ability to have an orgasm is unchanged, Dr. Renshaw points out, because arousal takes place in your clitoris and your mind.
Spinal Cord Injury
This type of injury does not have to close the book on sexual activity. In a 1995 study, half of 25 women with spinal cord injury reported the ability to achieve orgasm regardless of the pattern or degree of their neurological injury. What made the difference? The researchers credited greater sexual knowledge and higher sex drive.
Age-Related Changes
Hormonal changes, arthritis, heart disease, and other physical conditions may mean you'll have to adapt your activities accordingly, but there's no need to fall in with the myth that getting older means giving up sex. Freedom from pregnancy, comfort with one's body, and familiarity with your partner's responses can enhance sex in later years. In fact, data from the National Survey of Families and Households revealed that one quarter of married people over the age of 76 reported having sex at least once in the previous month.
Physical factors aren't the only causes of sexual dysfunction in women -- there also are psychological variables. These are addressed on the next page.
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