What is Female Sexual Dysfunction?
Many women initiate or agree to have sexual intercourse because they want:
- emotional closeness;
- to improve their health;
- to confirm their attractiveness;
- to satisfy their partner.
In established relationships, woman often lacks sexual desire, but as soon as sexual desire causes excitement and a sense of pleasure (subjective activation), genital tension (physical sexual activation) also appears.
The desire for sexual satisfaction, even in the absence of one or multiple orgasms during sexual intimacy, is physically and emotionally useful for initial stimulation of woman. Female sexual cycle is directly influenced by quality of her relationship with her partner. Sexual desire decreases with age, but increases with appearance of new partner at any age.
The physiology of female sexual reaction has not been fully studied, but it is associated with hormonal influence and is regulated by:
- central nervous system;
- subjective and physical activation and orgasm.
Estrogens and androgens also affect sexual activation. The production of androgens in postmenopausal period remains relatively constant, but adrenal androgen production begins to decrease in women after 40 years. It is unclear whether this decrease in hormone production plays a role in reducing sexual desire, interest or sexual activation.Androgens probably affect both:
- androgen receptors;
- estrogen receptors (after intracellular conversion of testosterone to estradiol).
Sexual Function Physiology
Excitement promotes activation of brain regions responsible for:
- genital tension formation.
This process involves neurotransmitters acting on specific receptors. Dopamine, noradrenaline and serotonin are of great importance in this process, despite the fact that serotonin, prolactin and aminobutyric acid are usually sexual inhibitors.
Genital excitement is a reflex autonomous response that appears during the first seconds after erotic stimulus and causes sexual tension and lubrication appearance. Smooth muscle cells around vulva vessels, clitoris and vaginal arterioles widen, increasing blood stasis, and interstitial fluid transudation with vaginal epithelium occurs in vagina (lubricant is produced). Women do not always know about congestion in genital organs, and this can occur without subjective activation. With women aging, basal genital blood flow decreases and tension in response to erotic stimuli (for example, erotic video) may be absent.
Orgasm is peak of excitement, which is characterized by contractions of pelvic muscles every 0.8 s and slow decrease in sexual excitement. Thoracolumbar sympathetic outflow tract may be involved in process, but orgasm is possible even after complete spinal cord discission (for example, when using vibrator to stimulate cervix). When orgasm starts, prolactin, antidiuretic hormone and oxy-toxin release, causing sense of satisfaction, relaxation or fatigue, which follow after sexual intercourse. However, many women experience sense of satisfaction and relaxation without experiencing orgasm.
Sexual Dysfunction in Women Causes
Traditional division of psychological and physical causes is artificial; psychological distress can be cause of change in physiology, and physical changes can lead to stress. There are several causes of disorders that lead to dysfunctions, etiology of which is unknown. Historical and psychological causes are causes that violate female psychosexual development. For example, cases of negative experience of sexual contacts in the past or other cases that may lead to decrease in self-esteem, shame or guilt.
Emotional, physical or sexual abuse in childhood or puberty can teach children to hide their emotions and control them (useful defense mechanism), but such inhibition in expression of their feelings can lead to difficulty in expressing sexual feelings in later period.
Traumatic events – early loss of parent or other loved one – can block intimacy with sexual partner because of fear to lose him.
Women with violations of sexual desire (interest) are prone to suffer from:
- low self-esteem.
They are characterized by mood instability even in absence of clinical disorders.
Women with orgasm disorder often have behavioral problems in case of non-sexual circumstances. A subgroup of women with dyspareunia and vestibulitis has high level of anxiety and fears of negative evaluation by surrounding people.
Contextual psychological sexual dysfunction causes are specific to current circumstances. They include:
- decreased attractiveness of sexual partner (for example, due to change in partner’s behavior as a result of increased attention to it by women);
- sexual sources of anxiety or stress (for example, because of family problems, at work, financial problems , cultural restrictions);
- anxiety associated with secret information about unwanted pregnancy, sexually transmitted diseases, lack of orgasm, erectile dysfunction in partner.
Medical causes that lead to female sexual dysfunction are associated with conditions causing:
- fatigue or weakness;
- atrophic vaginitis;
- bilateral ovarianectomy in young women;
- psychiatric disorders (eg anxiety, depression).
It is important to take drugs such as selective inhibitors of serotonin, beta-blockers and hormones. Oral estrogens and oral contraceptives increase level of steroid-binding a-globulin (SHBG) and reduce number of free androgens available for binding to tissue receptors. Antiandrogens (eg spironolactone and gonadotrophin releasing hormone agonists) can reduce sexual desire and sexual excitement.