Sexual Dysfunction in Women


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Publications International, Ltd.
Many myths still surround female sexual dysfunction. Learn how to separate the facts from fiction when diagnosing women's sexual problems.

With the arrival of Viagra, Levitra, and other similar drugs on the market, male sexual dysfunction became a hot topic -- and at the very least, men can take comfort in knowing there are millions of other men with similar problems.

The media hoopla over sexual dysfunction drugs has certainly helped educate the public: We have a much better understanding of the psychology and physiology of male sexual dysfunction, and we finally accept the simple fact that ED does not mean a man is a failure. And, even if men don't quite have their "magic bullet," they at least know that there is an array of treatment options.

So where does that leave women? In the following article, you'll find out. Here are the topics we'll cover:

  • Defining Female Sexual Dysfunction
    There still are a lot of myths associated with the sexuality of women -- it is not clearly understood. However, modern medicine has made a lot of progress on this front. Female sexual dysfunction is defined as an inability to experience pleasure during intercourse, but it now is noted that this isn't abnormal. Most women's sexual problems are not a cause for grave concern. In this section, we'll separate fact from fiction when it comes to defining female sexual dysfunction.

  • Physical Causes of Female Sexual Dysfunction
    In many cases, there is a physical cause of sexual difficulties for women. Hormones are the most common factor -- estrogen levels, for instance, play a large role in determining a woman's sexual drive. Certain prescription drugs also can interfere with how a woman functions sexually, including antidepressants, antibiotics, and diet aids. We'll examine all of the primary factors contributing to female sexual dysfunction, from those we mentioned above to fatigue and age-related changes.

  • Psychological Causes of Female Sexual Dysfunction
    Sometimes the reasons for female sexual dysfunction are mental, not physical. Depression, guilt, and conflicting emotions about your body all can lead to bad sexual experiences. There are, however, ways to combat this type of sexual dysfunction. For instance, couples need to have an open line of communication in order to maintain a healthy and vibrant sexual relationship. We'll explore the psychological causes of female sexual dysfunction and provide some possible solutions.

  • Learn More
  • Sexual Dysfunction Drugs for Women
    For men, drugs such as Viagra, Levitra, and Cialis have been godsends -- these medications have produced sexual rejuvenation. But what about women? Are there drugs that can help them function better sexually? So far, studies have been inconclusive. In theory, drugs such as Viagra should work for women, too, but more data needs to be compiled in this area. Read this page to find out whether medication can be a realistic solution for sexual dysfunction in women.

 

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

The brand name products mentioned in this publication are trademarks or service marks of their respective companies. The mention of any product in this publication does not constitute an endorsement by the respective proprietors of Publications International, Ltd. or HowStuffWorks.com, nor does it constitute an endorsement by any of these companies that their products should be used in the manner described in this publication.

Defining Female Sexual Dysfunction

The Sexual Revolution has come and gone, but women's sexuality is still shrouded in mystery and misconception. Not that long ago women were thought to be crazy or "bad" if they showed any interest in sex, and only a few generations have passed since hysterectomy was a routine solution to any number of physical and psychological conditions -- both real and perceived.

Medicine has come a long way in clarifying what constitutes function and dysfunction, but the medical community, and society as a whole, has a long way to go. A case in point is the debate in the psychiatric community over whether premenstrual syndrome exists, and if it does, whether it's classifiable as a "mental disease." Women want female sexual dysfunction to be taken seriously and to be investigated responsibly, just as male sexual dysfunction has been. And they want to know: Is Viagra, Levitra, or Cialis their magic bullet, too?

To find out, they need to understand exactly what female sexual dysfunction is. It usually is defined as an inability to experience sexual pleasure or as pain during intercourse. Dysfunction, however, doesn't mean abnormal. If a woman experiences either of those problems, she's far from alone.

In a study conducted by Irwin Goldstein, M.D., a former professor of urology at Boston University School of Medicine and a leading researcher in sexuality problems, 58 percent of 300 women interviewed reported some type of sexual dysfunction, such as discomfort during intercourse, dryness, increased time for arousal, diminished ability to achieve orgasm, or diminished clitoral sensation.

Sexual problems, even those that are physically based, are not necessarily something to worry about. Most women at some time feel unaroused at the thought of sex, and pressures of work or other stress can keep you from enjoying sex fully (which is unfortunate, because an orgasm is a great relaxant, as is intimacy).

A low libido could simply mean you're tired. Some symptoms, such as vaginal dryness, may be the normal consequences of aging, easily corrected with hormone replacement therapy or lubricants. The problem can be magnified if your partner takes Viagra, Levitra, or Cialis and gets firm, hard erections after years of a softer one.

The continuum of sexual response among women is so broad that inability to achieve orgasm is only considered dysfunction if a specific psychological inhibition or physical impairment is present. Famed sex therapists William Masters and Virginia Johnson, with co-author Dr. Robert Kolodny, say relatively few cases of orgasmic dysfunction have a medical cause.

Instead, they say it's more likely to be the result of a "negative mind set that the woman brings to a sexual situation," such as shame, embarrassment, resentment, or fear. Of course, we should remember that that's what was said about male sexual dysfunction, too.

The reasons for female sexual dysfunction are many and varied, ranging from depression to chronic illness to drug side effects. If you are concerned about any aspect of your sexual functioning, a visit to a gynecologist is in order.

In the next section, we'll examine some of the physical factors that lead to sexual dysfunction in women, including hormones, infection, and fatigue.

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.

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.

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 medical issues. These are addressed on the next page.

Medical Causes of Female Sexual Dysfunction

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.

Infection

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.

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.

Hysterectomy

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.

Medical factors aren't the only causes of sexual dysfunction in women -- there also are psychological variables. See the next page to learn more.

Psychological Causes of Female Sexual Dysfunction

Depression spreads its tentacles into every area of your life, from getting up in the morning to eating habits to social interaction. It's no surprise that one of the first casualties of depression is your sex life. Lack of energy, low self-esteem, and even guilt about not feeling "normal" can all rob you of desire.

Shame, guilt, and conflicted emotions about your body and sexuality, commonly due to early childhood experiences and teaching, can lead to vaginismus, as can sexual abuse, rape, and bad sexual experiences.

In vaginismus, the muscles in the lower vagina involuntarily contract so painfully tight that it's impossible to engage in intercourse. Vaginismus is reversible with relaxation techniques that allow the woman, in stages, to untense enough to insert her own finger, then the man's finger, and finally his penis. Talk to your gynecologist for more information and instruction in these techniques.

Intimacy

For many women, sexual desire and sexual response require intimacy -- and this is a fundamental difference between male and female sexual response. Ruth Jacobowitz, health advocate and columnist, explains that, "Men give love to get sex; women give sex to get love."

Although that generality may not hold true for all men and women, it is commonly believed that if you don't have a good relationship with your partner, you won't have a good sex life either. Self-esteem, self-confidence, feeling attractive, feeling loved and cared for -- these are often essential ingredients for arousal in a woman.

Timing

The categories of physical and psychological causes of sexual problems can be further broken down into those that are simply due to differences between men and women. For example, disparities in sexual drive are unfortunately a common source of frustration, blame placing, and, sometimes, hostility.

The truth is, it's rare for a couple to share the exact same desire at the exact same time. Negotiation and compromise are usually necessary. A man's cycle of arousal is generally faster than a woman's, which explains why the mutual orgasm, so sought after, isn't easy to achieve. It isn't a lack of compatibility, as many couples may decide, but a difference of about 3 minutes -- the man's cycle of arousal takes about 10 minutes versus 13 or so for the woman.

Again, communication is crucial. Couples can try extending foreplay to allow the woman time to catch up to her partner. Another option is for the woman to train herself through focused fantasy or other means to climax sooner or, alternatively, the man, finishing first, can concentrate on the woman's desires. Couples also need to experiment to find what's enjoyable and what's not. It's easy for a couple to get into a monotonous routine. Remember, variety is important.

Someday soon, medications might exist that could help women solve their sexual problems. Go to the next page to learn more about these potential breakthroughs.

Sexual Dysfunction Drugs for Women

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Publications International, Ltd.
Sexual dysfunction drugs originally designed for men -- like Viagra and Levitra -- may work for women, too.

Discovering the cause or causes of a woman's sexual difficulties will help her to resolve them. Many of the problems are reversible or treatable. The question uppermost in her mind might be: Can erectile dysfunction drugs orginally designed for men -- such as Viagra, Levitra, or Cialis -- be of help?

At the moment, the answer is maybe.

Studies have been inconclusive, although some results have shown that Viagra may increase lubrication for women. At $10 or so a pill, however, the price is pretty steep compared with the price of a tube of K-Y Jelly, Dr. Renshaw points out.
However, some researchers are hopeful. Myron Murdoch, M.D., a urologist and past director of the Impotence Institute of America, noting that a woman's clitoris is made of tissue similar to that in a man's penis, speculated that an oral medication could make it easier for a woman to become aroused.

Similarly, Dr. Goldstein, who initially was mentioned on the second page of this article, has said his research indicates the problem for women may be the same as for men: not enough blood flowing to the sex organs, perhaps due to vascular disease and aging. The clitoris, after all, is the female equivalent of the penis and becomes engorged with blood during arousal. And Goldstein also found that the women in his study who were more likely to have sexual problems had similar medical profiles to the men with erectile dysfunction.

In theory, at least, perhaps an oral medication could help women, too, if arousal depends on clitoral stimulation. (It's important to note that Dr. Goldstein is a paid consultant to many companies developing drugs to treat erectile dysfunction, including Pfizer, the maker of Viagra.) At this point, the FDA has not approved Viagra, Levitra, or Cialis for treatment of female sexual dysfunction.

The difficulty is measuring arousal in women. Not enough is known yet about women's sexual function, say some physicians, who believe it's therefore premature to test a drug's effects. But the findings about Viagra certainly have opened the door to the study of female sexual function.
The question of testing such a drug runs up against the same obstacles often found in research about women's health.

Until the last 20 years or so, most clinical trials included only white men, and effects on women and different ethnic groups were extrapolated from those study results. Now, as studies begin to establish gender differences in, for instance, how drugs are metabolized, researchers are beginning to spread their nets wider. However, some gender differences, such as the ability to get pregnant, still make it difficult to include women in some trials.

Recent studies underscore the importance of knowing some basics about how men's and women's bodies work. One, at the University of Georgia in Athens, found men's veins are more likely to contract and cause blood-flow problems than are women's. This difference alone could have huge implications for research into drug therapy.

Hope springs eternal and dies hard, though, and many women with sexual problems are just as eager for a magic bullet as the men who swamped the phone lines with calls about Viagra and other such drugs. Time will tell whether they will get an equal opportunity.

©Publications International, Ltd.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

The brand name products mentioned in this publication are trademarks or service marks of their respective companies. The mention of any product in this publication does not constitute an endorsement by the respective proprietors of Publications International, Ltd. or HowStuffWorks.com, nor does it constitute an endorsement by any of these companies that their products should be used in the manner described in this publication.


 

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