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Female sexual dysfunctionBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/female-sexual-dysfunction/DS00701
Persistent, recurrent problems with sexual response or desire — that distress you or strain your relationship with your partner — are known medically as female sexual dysfunction.
Many women experience problems with sexual function at some point in their lives. Female sexual dysfunction can occur at all stages of life, and it may be ongoing or happen only once in a while.
You may experience more than one type of female sexual dysfunction. Types include:
- Low sexual desire. You have diminished libido, or lack of sex drive.
- Sexual arousal disorder. Your desire for sex might be intact, but you have difficulty or are unable to become aroused or maintain arousal during sexual activity.
- Orgasmic disorder. You have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.
- Sexual pain disorder. You have pain associated with sexual stimulation or vaginal contact.
Sexual response involves a complex interaction of physiology, emotions, experiences, beliefs, lifestyle and relationships. Disruption of any of these components can affect sexual drive, arousal or satisfaction. Fortunately, female sexual dysfunction is treatable.
Female sexual dysfunction can happen at any age. Sexual problems often develop when your hormones are in flux — for example, after having a baby or during menopause. Sexual concerns may also occur with major illness, such as cancer, diabetes, or heart and blood vessel (cardiovascular) disease.
Your problems might be classified as female sexual dysfunction if you experience one or more of the following — and you're distressed about it:
- Your desire to have sex is low or absent.
- You can't maintain arousal during sexual activity, or you don't become aroused despite a desire to have sex.
- You can't experience an orgasm.
- You have pain during sexual contact.
When to see a doctor
If sexual problems affect your relationship or disrupt your peace of mind, make an appointment with your doctor for evaluation.
Several factors contribute to sexual dissatisfaction or dysfunction. These factors tend to be interrelated.
- Physical. Examples of physical conditions that may contribute to sexual problems include arthritis, urinary or bowel difficulties, pelvic surgery, fatigue, headaches, other pain problems, and neurological disorders such as multiple sclerosis. Certain medications, including some antidepressants, blood pressure medications, antihistamines and chemotherapy drugs, can decrease your sex drive and your body's ability to experience orgasm.
Hormonal. Lower estrogen levels after menopause may lead to changes in your genital tissues and sexual responsiveness. The folds of skin that cover your genital area (labia) become thinner, exposing more of the clitoris. This increased exposure sometimes reduces the sensitivity of the clitoris.
The vaginal lining also becomes thinner and less elastic, particularly if you're not sexually active, causing a need for more stimulation to relax and lubricate before intercourse. These factors can lead to painful intercourse (dyspareunia), and it may take longer to experience orgasm.
Your body's hormone levels also shift after giving birth and during breast-feeding, which can lead to vaginal dryness and can affect your desire to have sex.
Psychological and social. Untreated anxiety or depression can cause or contribute to sexual dysfunction, as can long-term stress. The worries of pregnancy and demands of being a new mother may have similar effects. Longstanding conflicts with your partner — about sex or other aspects of your relationship — can diminish your sexual responsiveness as well. Cultural and religious issues and problems with body image also may contribute.
Emotional distress can be both a cause and a result of sexual dysfunction. Regardless of where the cycle began, you usually need to address relationship issues for treatment to be effective.
Some factors may increase your risk of sexual dysfunction:
- Depression or anxiety
- Heart and blood vessel disease
- Neurological conditions, such as spinal cord injury or multiple sclerosis
- Liver or kidney failure
- Certain medications, such as antidepressants or high blood pressure medications
- Emotional or psychological stress, especially with regard to your relationship with your partner
- A history of sexual abuse
Preparing for your appointment
If you have ongoing sexual difficulties, such as low desire or lack of arousal, and it distresses you, make an appointment with your doctor. You may feel embarrassed to talk about sex with your doctor, but this topic is perfectly appropriate. A satisfying sex life is important to a woman's well-being at every age and stage of life.
You may have a treatable, underlying condition, or you may benefit from lifestyle changes, therapy or a combination of treatments. Your primary doctor may diagnose and treat the problem or refer you to a specialist.
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
Gather information about:
- Your symptoms. Take note of any sexual difficulties you're having, including when and how often you usually experience them.
- Your sexual history. Your doctor likely will ask about your relationships and experiences since you first became sexually active. He or she also may ask about any history of sexual trauma or abuse.
- Your medical history. Write down any medical conditions with which you've been diagnosed, including mental health conditions. Note the names and strengths of medications you take or have recently taken, including prescription and over-the-counter drugs.
- Questions to ask your doctor. Create a list of questions in advance to make the most of your time with your doctor.
Basic questions to ask your doctor
Consider asking your doctor questions such as:
- What may be causing my sexual difficulties?
- Do I need any medical tests?
- What treatment approach do you recommend?
- If you're prescribing medication, are there any possible side effects?
- How much improvement can I reasonably expect with treatment?
- Are there any lifestyle changes or self-care steps that may help me?
- Do you recommend therapy?
- Should my partner be involved in treatment?
- Do you have any printed material that I can have? What websites do you recommend?
Don't hesitate to ask more questions during your appointment as they occur to you.
What to expect from your doctor
Your doctor may ask a number of personal questions and may want to include your partner in the interview. To help determine the cause of your problem and the best course of treatment, be ready to answer questions such as:
- What problems are you currently experiencing?
- How much do these problems bother you?
- How satisfied are you with your current relationship?
- When did you first become sexually active?
- Do you become aroused during sexual interactions with your partner?
- Do you experience orgasm?
- If you've had orgasms in the past, what were the circumstances?
- Do you have pain with intercourse?
- Are you using any form of birth control? If yes, what form?
- What medications are you taking, including prescription and over-the-counter drugs as well as vitamins and supplements?
- Do you use alcohol or recreational drugs? How much?
- Have you ever had surgery that involved your reproductive system?
- Have you been diagnosed with any other medical conditions, including mental health conditions?
- Have you ever been the victim of sexual violence?
What you can do in the meantime
Keep the lines of communication open with your partner. Be honest about your dissatisfaction or the problem you're experiencing. Consider alternatives for intimacy and engage in sexual activities that are relaxing and rewarding for both of you. In this way, you can be intimate and ease the stress of the situation.
Tests and diagnosis
To diagnose female sexual dysfunction, your doctor will:
- Discuss your sexual and medical history. You might be uneasy talking with your doctor about such personal matters, but your sexuality is a key part of your well-being. The more forthcoming you can be about your sexual history and current problems, the better your chances of finding an effective approach to treating them.
- Perform a pelvic exam. During the exam, your doctor checks for physical changes that affect your sexual enjoyment, such as thinning of your genital tissues, decreased skin elasticity, scarring or pain.
Your doctor may also refer you to a counselor or therapist specializing in sexual and relationship problems.
Treatments and drugs
Female sexual dysfunction has many possible symptoms and causes, so treatment varies. Communicating your concerns and understanding your body and its normal response to sexual activity are important steps toward gaining sexual satisfaction.
Women with sexual concerns most often benefit from a combined treatment approach that addresses medical as well as relationship and emotional issues.
Nonmedical treatment for female sexual dysfunction
To treat sexual dysfunction, your doctor might recommend that you start with nonmedical strategies:
- Talk and listen. Open, honest communication with your partner makes a world of difference in your sexual satisfaction. Even if you're not used to talking about your likes and dislikes, learning to do so and providing feedback in a nonthreatening way sets the stage for greater intimacy.
- Practice healthy lifestyle habits. Go easy on alcohol — drinking too much can blunt your sexual responsiveness. Stop smoking — smoking restricts blood flow to your sexual organs, decreasing sexual arousal. Be physically active — regular physical activity can increase your stamina and elevate your mood, enhancing romantic feelings. Learn ways to decrease stress so you can focus on and enjoy your sexual experience.
- Seek counseling. Talk with a counselor or therapist who specializes in sexual and relationship problems. Therapy often includes education about how to optimize your body's sexual response, ways to enhance intimacy with your partner, and recommendations for reading materials or couples exercises.
- Use a lubricant. A vaginal lubricant may be helpful during intercourse if you experience vaginal dryness or pain during sex.
- Try a device. Arousal improves with stimulation of the clitoris. Use a vibrator to provide clitoral stimulation. Although some women find clitoral vacuum suction devices helpful for enhancing sexual arousal, those devices can be cumbersome.
Medical treatment for female sexual dysfunction
Effective treatment for sexual dysfunction often requires addressing an underlying medical condition or hormonal change.
To treat sexual dysfunction tied to an underlying medical condition, your doctor might recommend that you:
- Adjust or change medication that has sexual side effects
- Treat a thyroid problem or other hormonal condition
- Optimize treatment for depression or anxiety
- Try strategies for relieving pelvic pain or other pain problems
Treating female sexual dysfunction linked to a hormonal cause might include:
- Estrogen therapy. Localized estrogen therapy comes in the form of a vaginal ring, cream or tablet. This therapy benefits sexual function by improving vaginal tone and elasticity, increasing vaginal blood flow and enhancing lubrication.
- Androgen therapy. Androgens include male hormones, such as testosterone. Testosterone plays a role in healthy sexual function in women as well as men, although women have much lower amounts of testosterone. Androgen therapy for sexual dysfunction is controversial, however. Some studies show a benefit for women who have low testosterone levels and develop sexual dysfunction; other studies show little or no benefit.
The risks of hormone therapy may vary, depending on whether estrogen is given alone or with a progestin, your age, the dose and type of hormone, and health issues such as your risks of heart and blood vessel disease and cancer. Talk with your doctor about benefits and risks. In some cases, hormonal therapy might require close monitoring by your doctor.
Potential treatments that need more research
More research is needed before these agents might be recommended for treatment of female sexual dysfunction:
- Tibolone. Tibolone is a synthetic steroid drug currently used in Europe and Australia for treatment of postmenopausal osteoporosis. In one randomized trial, postmenopausal women taking the drug experienced an improvement in overall sexual function and a reduction in personal distress compared with postmenopausal women taking estrogen, but the effect was small. Due to concerns over increased risk of breast cancer and stroke in women taking tibolone, the drug isn't approved by the Food and Drug Administration for use in the U.S.
- Phosphodiesterase inhibitors. This group of medications has proved successful in treating erectile dysfunction in men, but the drugs don't work nearly as well in treating female sexual dysfunction. Studies looking into the effectiveness of these drugs in women show inconsistent results. One drug, sildenafil (Viagra), may prove beneficial for some women who experience sexual dysfunction as a result of taking selective serotonin reuptake inhibitors (SSRIs), a class of drugs used to treat depression. However, don't take sildenafil if you use nitroglycerin for angina — a type of chest pain caused by reduced blood flow to the heart.
Issues surrounding female sexual dysfunction are usually complex, so even the best medications aren't likely to work if other emotional or social factors remain unresolved.
Lifestyle and home remedies
To boost your sexual health, practice these healthy lifestyle habits:
- Avoid excessive alcohol. Drinking too much blunts sexual responsiveness.
- Don't smoke. Cigarette smoking restricts blood flow throughout your body. Less blood reaches your sexual organs, which means you could experience decreased sexual arousal and orgasmic response.
- Be physically active. Regular aerobic exercise increases your stamina, improves your body image and elevates your mood. This can help you feel more romantic, more often.
- Make time for leisure and relaxation. Learn ways to decrease stress, and allow yourself to relax amid the stresses of your daily life. Being relaxed can enhance your ability to focus on your sexual experiences and may help you attain more satisfying arousal and orgasm.
More research is needed, but promising therapies for improving sexual satisfaction include:
- Mindfulness. This type of meditation is based on being mindful, or having an increased awareness and acceptance of living in the present moment. You focus on what you experience during meditation, such as the flow of your breath. You can observe your thoughts and emotions but let them pass without judgment. Some research shows that mindfulness practiced during the course of group therapy improved many aspects of sexual response and reduced personal distress in women with desire and arousal disorders.
- Acupuncture. Acupuncture involves the insertion of extremely thin needles into your skin at strategic points on your body. Acupuncture may have positive effects on women with sexual pain disorders. Another possible therapy is acupuncture to improve libido in women with low desire, although this area has yet to be rigorously studied.
- Yoga. During yoga, you perform a series of postures and controlled breathing exercises to promote a more flexible body and a calm mind. Certain subsets of yoga aim to channel the body's sexual energy and improve sexual functioning. Very little data exist on the benefits of yoga on sexual functioning. However, the practice of yoga is associated with improved psychological well-being and overall health.
Coping and support
At each stage of your life, you may experience changes in sexual desire, arousal and satisfaction. To better adapt:
- Understand your body and what makes for a healthy sexual response. The more you and your partner know about the physical aspects of your body and how it functions, the better able you'll be to find ways to ease sexual difficulties.
- Gather information. Ask your doctor or look for educational materials to learn how issues such as aging, illnesses, pregnancy, menopause and medicines might affect your sex life.
- Communicate openly with your partner. Be flexible in your approach to intimacy with your partner. Continue to engage in the areas of intimacy that are working well for the two of you.
- Accept changes that occur. Explore new aspects of your sexuality during times of transition to improve your sexual experiences.
Sexual response often has as much to do with your feelings for your partner as it does with physical sexual stimuli. Reconnect and discover each other again.
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