Female sexual dysfunction

Female sexual dysfunction is a medical term for ongoing sexual problems that upset you or your partner. Problems may involve sexual response, desire, orgasm or pain during sex.

Many people have sexual problems at some point. Some have them throughout their lives. Female sexual dysfunction can happen at any stage of life. It can happen only sometimes or all the time during sex.

Sexual response is complex. It involves how your body works, your feelings, things that happen in your life, your beliefs, your lifestyle and how you relate to your partner. A problem in any one of these areas can affect sexual desire, arousal or satisfaction. Treatment often involves more than one approach.

Symptoms vary depending on the type of sexual dysfunction. Symptoms may include:

• Low sexual desire. This most common of female sexual dysfunctions involves a lack of interest in sex and not wanting to have sex.
• Sexual arousal disorder. Even if you want sex, sometimes it may be hard to get or stay aroused during sex.
• Orgasmic disorder. You have ongoing trouble having an orgasm even with enough sexual arousal.
• Sexual pain disorder. You have pain when having sex.

When to see a doctor

If sexual problems affect your relationship or worry you, make an appointment with a member of your healthcare team.

Sexual dysfunction problems often start when hormones change. This might be after having a baby or during menopause. Major illness, such as cancer, diabetes or heart disease, also can add to sexual dysfunction.

Factors that add to sex problems include the following:

• Physical. Medical conditions can lead to sexual dysfunction. These may include cancer, diabetes, kidney failure, multiple sclerosis, heart disease and bladder problems. Certain medicines can decrease your sexual desire and make it harder for you to have an orgasm. These include some medicines to treat depression, high blood pressure, allergies and cancers.

• Hormonal. Lower estrogen levels after menopause may lead to changes in your genital tissues and how you respond to sex. Lower estrogen leads to less blood flow to the pelvis. This can cause you to have less feeling in your genitals and to need more time to become aroused and reach orgasm.

  The vaginal lining also becomes thinner and less stretchy. Not being sexually active can make this worse. These factors can lead to painful intercourse, called dyspareunia. Sexual desire also lessens when hormone levels drop.

  Your body's hormone levels shift after giving birth and during breastfeeding. This can lead to vaginal dryness and affect your desire for sex.

• Psychological and social. Anxiety or depression that isn't treated can cause sexual dysfunction or add to it. So can long-term stress, a history of sexual abuse, worries of pregnancy and the demands of having an infant.

  Problems with your partner can affect your sex life. So can cultural and religious issues and problems with body image.

Factors that may increase your risk of sexual dysfunction:

• Depression, anxiety and other mental health conditions.
• Heart disease, diabetes, cancer.
• Conditions of the spine and brain, called neurological. Examples are spinal cord injury or multiple sclerosis.
• Gynecological conditions, including infections.
• Certain medicines, such as those taken for depression or high blood pressure.
• Emotional or psychological stress, especially stress in your relationship with your partner.
• A history of sexual abuse.
• Lack of privacy.

To diagnose female sexual dysfunction, your healthcare professional may:

• Discuss your sexual and medical history and your gender identity. You might be uneasy talking about such personal matters. But your sexuality is a key part of your well-being. Being open about your sexual history and current problems raises your chances of finding a way to treat them.
• Do a pelvic exam. During the exam, your healthcare professional checks for physical changes that can affect how much you enjoy sex. These include thinning of your genital tissues, scarring or pain.
• Order blood tests. Blood tests can check for health conditions that might be part of sexual dysfunction.

Your healthcare professional also may suggest that you see a counselor or therapist who treats sexual and couples' problems.

Sexual dysfunction is a problem only if it bothers you. If it doesn't bother you, you don't need treatment. But if your sexual dysfunction hurts your relationship with your partner, then seeing a counselor or therapist together may be helpful.

Female sexual dysfunction has many possible symptoms and causes, so treatment varies. You need to tell your healthcare professional your concerns.

You also need to know how your body responds to sex and what you want from sex. These will help with choosing a treatment and knowing whether it works for you.

Most often, a mix of treatments that includes medical, relationship and emotional issues works best.

Nonmedical treatment for female sexual dysfunction

To treat sexual dysfunction, your healthcare professional might suggest the following:

• Talk and listen. You need to talk openly with your partner to have a good sex life. Maybe you're not used to talking about what you want. But learning to do so and giving feedback in a way that doesn't threaten can strengthen your bond as a couple.

• Live healthy. Lifestyle changes that improve health and well-being also can help improve sex life. Limit alcohol. Drinking too much can blunt your response to sex. Be physically active. Physical activity can give you more energy and put you in a better mood.

  Learn ways to lower stress. This will help you focus on sex and enjoy it.

• Seek counseling. Talk with a counselor or therapist who works with sexual problems. Therapy often includes learning about your body and ways to be closer to your partner.
• Use a lubricant. A vaginal lubricant may help during intercourse if you have vaginal dryness or pain during sex.
• Use a vaginal moisturizer. You can use this anytime to ease vaginal dryness.
• Stay sexually active. Do this by yourself or with a partner. This also can ease vaginal discomfort by increasing blood flow to the vagina.
• Use a device. Devices such as vibrators help with orgasm by increasing blood flow to the clitoris.

Medical treatment for female sexual dysfunction

Treatment for sexual dysfunction often involves dealing with a medical condition or hormonal change. Your healthcare professional may suggest changing a medicine you take or lowering the dose.

Treatments for female sexual dysfunction might include:

• Vaginal estrogen. To relieve vaginal dryness, you can apply estrogen to the vagina using a vaginal cream, tablet or ring. This treatment gives you a small amount of estrogen, which the vaginal tissues take in. It can help ease vaginal dryness, pain with intercourse and some urinary symptoms.
• Ospemifene (Osphena). Taken by mouth, this selective estrogen receptor modulator (SERM) medicine treats painful intercourse linked to the thinning of vaginal tissue. This medicine isn't for people who have had breast cancer or who are at high risk of breast cancer.
• Testosterone therapy. Testosterone plays a role in healthy sexual function in women as well as men. But there are no testosterone treatments approved for use in females for sexual dysfunction. That's because of concerns about how well it works and how safe it is. If you want testosterone therapy, talk with a member of your healthcare team about the risks and benefits.

• Flibanserin (Addyi). This was first used as an antidepressant. The Food and Drug Administration (FDA) has approved it for use before menopause to treat low sexual desire.

  This daily pill may boost sex drive. You take it once a day at bedtime. Possible serious side effects include having low blood pressure, getting sleepy, tired and dizzy. It also can cause nausea and fainting.

  Mixing this medicine with alcohol can make side effects worse. Experts suggest stopping the medicine if your sex drive hasn't improved after eight weeks.

• Bremelanotide (Vyleesi). Bremelanotide is another FDA-approved treatment for low sexual desire in premenopausal people. This medicine is a shot you give yourself just under the skin in the belly or thigh before having sex.

  Some people have nausea. This is more common after the first shot. It tends to get better with the second shot. Other side effects include vomiting, flushing, headache and a skin reaction at the site of the shot.

• Prasterone (Intrarosa). You put this insert or suppository of human-made hormone dehydroepiandrosterone (DHEA) into the vagina. It helps ease vaginal dryness and pain with intercourse.

Potential treatments that need more research

Researchers are studying these treatments for female sexual dysfunction:

• Tibolone. People in Europe use this medicine that has female and male hormone actions. Because of worry that it might increase the risk of breast cancer and stroke, the FDA hasn't approved it for use in the U.S.

• Phosphodiesterase inhibitors. This group of medicines has had success in treating not being able to get and keep an erection, called erectile dysfunction. But the medicines don't work as well for female sexual dysfunction. Results of studies of women taking these medicines have been mixed.

  One medicine, sildenafil (Revatio, Viagra), may prove useful for some people who have sexual dysfunction from taking a class of medicines used to treat depression. These are selective serotonin reuptake inhibitors (SSRIs). Don't take sildenafil if you use nitroglycerin for a type of chest pain caused by lower blood flow to the heart, called angina.

Because female sexual dysfunction is complex, even the best medicines aren't likely to work if other emotional or social factors are not resolved.

To boost your sexual health, find ways to be OK with your sexuality, improve your self-esteem and accept your body. Try these healthy lifestyle habits:

• Don't drink too much alcohol. Drinking too much gets in the way of sexual response.
• Don't smoke. Cigarette smoking restricts blood flow. Less blood reaches your sexual organs. This could lower your sexual arousal and keep you from having an orgasm.
• Be physically active. Regular aerobic exercise can give you more energy, help you feel better about your body and put you in a better mood. This can help you feel more romantic more often.
• Learn to relax. Learn ways to lower stress and let yourself relax. Being relaxed can help you focus during sex. And it may help improve arousal and help you have an orgasm.

More research is needed, but therapies that may help improve sex include:

• Cognitive behavior therapy. This type of therapy can help you change thoughts, feelings and behaviors that aren't healthy. It's been shown to reduce how much menopause symptoms bother you.
• Mindfulness. This is a type of meditation used to increase awareness and help you accept the present. You focus on one thing during meditation, such as the flow of your breath. You let your thoughts and emotions pass without judging them.
• Yoga. During yoga, you do a series of postures and controlled breathing exercises. This helps you move your body better and calms your mind. Some types of yoga aim to improve sex.

There are also some herbal supplements and topical oils sold to increase sex drive and sexual pleasure. But these products haven't been studied well. One product with estrogen-like action may spur the growth of breast tumors that feed on estrogen. Talk to your healthcare professional before trying any herbal or topical oil products.

If you have sex problems that upset you, make an appointment with your healthcare professional. Don't be shy talking about sex with your healthcare professional.

You might have a condition that can be treated. Or lifestyle changes, therapy or a mix of treatments might help. Your main healthcare professional will either diagnose and treat the problem or refer you to a specialist.

Here's some information to help you get ready for your appointment.

What you can do

Make a list of the following:

• Your symptoms. Take note of any sexual problems you're having, including when and how often they occur.
• Your sexual history. Write about your relationships and the sex you've had since you started having sex. Be ready to talk about any history of sexual trauma or abuse.
• Your medical history. Write down medical conditions you have, including mental health conditions. Make a list of the medicines you take or have taken recently, including doses.
• Questions to ask your healthcare professional. Make a list of questions to make the most of your appointment time.

Some basic questions to ask about your sexual concerns include:

• What might be causing my sexual problems?
• Do I need medical tests?
• What treatment do you suggest?
• What can I expect from treatment?
• Do you think my partner and I should talk to a sex therapist?
• Are there printed materials I can have? What websites do you suggest?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare professional might ask personal questions and might want to include your partner in the interview. Questions might include:

• How much do your sexual problems bother you?
• How is your relationship?
• Do you become aroused during sex with your partner?
• Do you have orgasms?
• Have you had orgasms in the past but no longer can?
• Do you have pain with intercourse?
• What form of birth control or hormones, if any, do you use?
• Do you use alcohol or recreational drugs? How much?
• Have you ever had surgery that involved your reproductive system?

What you can do in the meantime

Talk with your partner. Be honest about the problem you have. Think about other ways to be close to each other. Make time to be intimate.