Female Sexual Dysfunction

What is female sexual dysfunction (FSD)?

Many women have a low sex drive or trouble having an orgasm. Some women are not bothered by this, but others are. A woman has female sexual dysfunction, also called FSD, when she is upset or unhappy about her sexual health. Studies show that about 33% of American women have low sex drive. Of those, about one in three women are upset about having low sex drive. That’s about 10% of all women in the United States.

There are several types of sexual dysfunction:

• Low sexual desire
• Trouble becoming aroused
• Trouble having an orgasm
• Pain during sex

A woman might have more than one of these issues, which are often related to each other. Sexual dysfunction can be lifelong or temporary. It can happen all the time, only with a certain partner, or only at certain times, such as after pregnancy.

A healthy sex life depends on a complex mix of many factors. The same is true for a troubled sex life. Health issues, certain prescription medicines, changes in hormone levels, partner or family issues, and psychological concerns can all contribute to FSD.

What are the causes of FSD?

General Physical

• Health problems: diabetes, heart disease, cancer, arthritis, multiple sclerosis, or alcohol abuse
• Medicines to treat high blood pressure, depression, pain; oral contraceptives

Gynecological

• Medical conditions such as endometriosis, cystitis, pelvic muscle problems, or chronic pelvic pain
• Pelvic or genital surgeries that cause scarring, decreased blood flow, or nerve damage to the genital area

Hormonal

• A drop in estrogen levels from menopause (natural or surgical) or premature ovarian failure (when the ovaries stop working before age 40), which can cause vaginal dryness and painful intercourse
• Possibly, a drop in levels of testosterone, which women produce in small amounts, after removal of the ovaries*

Psychological and Emotional

• Mental distress: stress, anxiety, depression, eating disorders, past sexual abuse, fear of unwanted pregnancy
• Relationship issues: boredom, anger, abuse (physical or emotional)
• Religious or cultural beliefs about sex

What treatments are available for FSD?

Choice of treatment depends on the cause of your problems. Often, a combination of treatments works best. If you have a medical condition that is causing your FSD, talk with your doctor about what can be done.

Talking and Counseling. Consider talking with your partner about what’s going on. Sometimes a better line of communication is all that is needed. If necessary, you may want to get counseling, by yourself or with your partner. Sex therapy, usually a later step in the process, also can be helpful.

Lifestyle Changes. Some women find that losing weight, eating a healthy diet, exercising, stopping smoking, and getting enough sleep helps increase their sense of well-being and interest in sex. Try finding ways to be comfortable with your own sexuality. This may involve thinking about your attitudes toward sex when you were growing up, finding ways to improve your self-esteem, and accepting your body as it is.

Managing Medicines. If certain medicines are causing problems, your doctor might be able to change your prescription. Other medicines also can help.

Estrogen. Estrogen can help with vaginal dryness and painful intercourse. Two types of prescription estrogen are available: local (vaginal) and whole-body (systemic).

• Local estrogen comes in very low doses and is inserted into the vagina as a cream or tablet. It also comes in a vaginal ring. Local treatment doesn’t have the health risks of whole-body estrogen because only small amounts of estrogen reach the bloodstream.
• Whole-body estrogen, also called hormone therapy, is taken as a pill, skin patch, gel, or spray. Because it affects the whole body, it has some health risks, such as stroke and blood clots. These events are rare in healthy women using hormone therapy close to menopause. Women who have not had a hysterectomy also need to take progestin, another female hormone, to prevent uterine cancer.

Other Medicines.

• Non-prescription treatments, which are hormone-free and have few side effects, can help. They include moisturizers applied to the vagina several times a week or lubricants for the vagina, used just before intercourse.
• Testosterone, when used short-term (a year or two), may increase sex drive in some women. Testosterone products for women are approved in some countries but not in the United States. The long-term safety of testosterone for women has not been proven and is being studied.*

*Most research does not show a link between testosterone levels and FSD

Devices. A prescription device called the Eros can help with arousal by increasing blood flow to the genital area and enhancing sensation.

Questions to ask your doctor

Keep in mind that some doctors have not been trained to treat sexual problems. Ask your doctor whether he or she feels comfortable working with you on your sexual health. If not, ask whether he/she can recommend an expert who could help you.

Before you ask your health care provider any questions, think about what you’d like to say. Think of ways to speak frankly and plainly, and try to be as specific as possible. You can use one of the statements below and add personal details.

• I am dissatisfied/unhappy/disappointed with my sex life because __________
• There have been changes in my sexual relationship with my partner: _______

Additional questions

• What are my options for treatment?
• Will treatment relieve my symptoms?
• What are the risks and benefits of each treatment option?
• How long will I need treatment?
• Should I see a specialist? e.g. gynecologist, therapist