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Updated May 17, 2006

Female Sexual Dysfunction

A blanket term to describe several sexual disorders affecting women, including lack of desire, difficulty becoming sexually aroused, difficulty reaching orgasm, and painful intercourse. By some estimates, anywhere from 19% to 50% of women have some type of sexual dysfunction. Women’s sexual difficulties may have a variety of underlying causes, both physical and emotional. Compared with men’s sexual dysfunction, very little is known about the causes of female sexual dysfunction or how to treat it, but this is now the focus of intense research and interest. Generally, female sexual disorders are defined as follows:

• Hypoactive sexual desire disorder. Refers to a lack of sexual desire, fantasies, or thoughts that causes the woman distress. Decreased desire may be caused by emotional or relationship factors, frustration from other sexual problems, or by a number of medicines, including many antidepressants, drugs for high blood pressure, and some oral contraceptives.
• Sexual aversion disorder. A persistent aversion to and avoidance of sexual contact because it elicits feelings of revulsion, fear, or anger. This disorder is generally psychologically-based and tends to occur in women who have been sexually abused or subscribe to strict religious taboos against sexual activity.
• Sexual arousal disorder. The inability to reach or maintain adequate sexual excitement (including genital lubrication or swelling) for sexual activity. Women with diabetes may be more prone to this disorder, because diabetic neuropathy or atherosclerosis can diminish sensation or blood supply in the vagina and clitoris.
• Orgasmic disorder. A persistent difficulty or inability to achieve orgasm following sexual stimulation or arousal. It can have a number of causes, including emotional trauma, hormone deficiencies, or nerve damage due to diabetic neuropathy or surgery.
• Sexual pain disorders.

Dyspareunia refers to genital pain during intercourse. Vaginismus is a recurrent or persistent involuntary spasm of the muscles in the outer part of the vagina that interferes with penetration. Sexual pain disorders may have physical or emotional causes.

Often, several of these conditions can coexist and reinforce each other. For example, lack of arousal or pain during intercourse can create unsatisfying sexual experiences, which can lead to decreased desire and decreased arousal in subsequent experiences. Decreased desire results in inadequate lubrication and can continue to cause painful sex. Women who experience any of these conditions and find it distressing should discuss symptoms with their gynecologist or other health-care provider. A number of medical and nonmedical treatments, including the following, can help alleviate symptoms of sexual dysfunction and enhance a woman’s sexual pleasure.

• Experimenting with erotic books and videotapes, fantasizing, and varying sexual routines can help with desire and arousal disorders.
• Some therapists suggest that a sensual but nonsexual massage may help to increase the comfort and communication between sex partners.
• Learning to perform relaxation or Kegel exercises during intercourse may help to improve sexual satisfaction and the ability to achieve orgasm. Experimenting with different sex positions may help as well.
• Some women with arousal disorders, especially those who are postmenopausal, may benefit from estrogen therapy. In some cases, it may be necessary to supplement estrogen supplements with an estrogen-containing vaginal cream. Vaginal lubricants may also help women with inadequate natural lubrication.
• Women with sexual pain disorders may benefit from learning progressive muscle relaxation and vaginal dilation exercises.
• In some cases, sex therapy or counseling may help women address a number of underlying issues, including anxiety, depression, guilt, past sex abuse, or loss of self-confidence, that are interfering with their enjoyment of sex. It may also be helpful to have the sex partner involved.

This article was written by Robert S. Dinsmoor, a Contributing Editor of Diabetes Self-Management.

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