Sexual Dysfunction in Women

Basics

  • Very common: ~40% of women surveyed in the United States have concerns regarding sexual function.
  • May present as a lack of sexual desire, impaired arousal, inability to achieve orgasm or pain with sexual activity, and may be lifelong or acquired

Description

  • Female sexual interest or arousal disorder
  • Subjective sexual arousal disorder
  • Genital sexual arousal disorder
  • Female orgasmic disorder
  • Genitopelvic pain or penetration disorder, which can include dyspareunia, vaginismus, and sexual aversion disorder
  • Substance/medication-induced sexual dysfunction

Epidemiology

In two large studies, approximately 40% of women reported concerns regarding sexual dysfunction.

Incidence
Sexual dysfunction is highest in women aged 45 to 64 years and then decline secondary to changes in sexual-related personal distress.

Prevalence

  • Low sexual desire is the most common manifestation, followed by difficulty with arousal, difficulty with orgasm, and sexual pain.
  • Lack of interest in sexual activity is notably greater than the normal decrease experienced with increasing age and relationship duration.

Etiology and Pathophysiology

The pathophysiology of sexual dysfunction is complex and multifactorial.

  • Biologic
    • Disorders of the hypothalamic-pituitary-adrenal system, hormonal imbalance/disorders of ovarian function, menopause, chronic illness; prescription medications; thyroid disease; neuromuscular disease; malignancy
  • Psychological:
    • Anxiety/depression, maladaptive thoughts/behaviors, interrelational difficulties, body image issues, drug and alcohol abuse, sexual abuse

Genetics
Sexual dysfunction in women is a multifactorial issue, often including a combination of biologic and psychosocial causes.

Risk Factors

  • Genitourinary syndrome of menopause
  • Previous sexual trauma
  • Lack of knowledge about sexual stimulation and response
  • Chronic medical problems: depression, anxiety, chronic pain syndromes, and other psychiatric disorders; cardiovascular disease; endocrine disorders; dermatologic disorders; neurologic disorders; cancer
  • Gynecologic issues: childbirth, pelvic floor or bladder dysfunction, endometriosis, uterine fibroids, chronic vulvovaginal candidiasis/vaginal infections, female genital mutilation
  • Relationship factors such as couple discrepancies in expectations and/or cultural backgrounds and attitudes toward sexuality in family of origin
  • Medications or substance abuse

Commonly Associated Conditions

Marital/relationship discord, depression, anxiety

There's more to see -- the rest of this topic is available only to subscribers.