Do you struggle to climax? Maybe you just don’t have any interest in sex, or you just don’t feel horny. Is penetrative vaginal sex painful? Do you avoid sex due to the anticipation of pain? Do your pelvic or lower abdominal muscles feel tense? These symptoms can all be part of a condition called Female Sexual Dysfunction (FSD). It is estimated to affect up to 40% of women, yes, up to 40%! It is more common with increasing age. In FSD, more than one of these problems can co-exist, and in some cases, all of them.
Your sexual function is controlled by several factors all working together, hormones, your nerves and brain, emotions, and blood vessels. Any one or more of these factors and the communication signals between them can be disrupted and lead to symptoms of FSD. For this reason, the management of FSD can potentially be quite complex.
It is important to mention that FSD is different from asexuality. Asexuality is an umbrella term for sexual orientations that involve varying degrees of sexual and romantic attraction towards others. It is not a medical condition
What causes FSD?
You need good levels of testosterone, oestrogen and progestogen hormones for good sexual function. Yes, you heard right! Testosterone is important for normal sexual function. It plays a significant role in your level of libido and arousal. Oestrogen and Progestogen are important hormones for keeping your sex organs healthy. It’s then not surprising then that around 85% of women who have been through the menopause (either naturally or artificially) report symptoms of FSD as levels of all three of these hormones fall during the menopausal period. The pelvic floor muscles play a very important role in maintaining sexual function. If certain muscles of the upper vagina are very tense or go into ‘spasm’, this can lead to painful penetrative sex, a condition known as ‘vaginismus’. Conversely, weak vaginal muscles can lead to reduced sensitivity and problems with orgasm.
Diabetes and Thyroid problems are conditions where there is hormonal disruption and can be associated with symptoms of FSD. Hormonal and physical changes that occur in pregnancy (typically in the first and third trimesters), the period immediately after childbirth (postpartum), and breast-feeding can all lead to symptoms of FSD.
We need an intact brain and nervous system for normal sexual function, so conditions that affect the brain and nerves such as Parkinson’s disease, multiple sclerosis, stroke, spinal cord disruption can all lead to symptoms of FSD. A healthy state of mind is essential. Conditions that affect mental well-being such as depression, anxiety, post-traumatic stress disorder and obsessive-compulsive disorders can negatively impact your sexual function. Very important considerations include, the quality of interpersonal relationships, cultural factors, and intercurrent economic stressors, lack of sex education, and relationship dissatisfaction. Many people lack knowledge on what makes sex enjoyable for females.
Certain medications can negatively impact sexual function. Some include: anti-depressants, blood pressure-lowering medication, oral contraceptive pills, anti-seizure medication, anti-hormone treatments, alcohol, anti-histamines and sedatives. Heart and blood vessel disease can also lead to symptoms of FSD as blood flow to sexual organs can be affected.
So what’s the approach to managing FSD?
It’s important to explore symptoms in detail. Questions might seem a bit intimate or probing but are key to understanding where the problem(s) may lie and how to best approach these. In addition to your symptoms, it is important to explore any potential, psychosocial, emotional, and mental health problems, your existing and past medical history, including all medication. Furthermore, we need to identify what your treatment priorities are as this helps to guide and home in on the right management for you. An examination is essential and investigations are usually required to exclude any hormonal imbalances or deficiencies.
It is important to mention that in some cases, there are no specific medications, quick fixes, or remedies to treat the problem(s) associated with FSD, but rather, it’s about agreeing on strategies that can help make the symptoms less troublesome or impactful.
