Arousing a lost arousal

Female sexual dysfunction (FSD) may not be as known and discussed as male dysfunctions, but it is still common. Shana Marie Buttigieg, from the Malta Medical Students’ Association, says FSD can be treated and it is important for a woman to talk to her gynaecologist.

Female sexual dysfunction (FSD) refers to a complex of persistent and recurrent problems with a female’s sexual response. It is a condition that is not as commonly known as erectile dysfunction in males.

FSD is characterised by various sexual problems, including low sexual desire, loss of sexual arousal, problems with orgasm and pain during sex. These prevent the woman from experiencing satisfaction from the sexual activity, which may strain the couple’s relationship, leading to distress.

Research suggests that about 50 per cent of women experience sexual dysfunction, and even though this condition is treatable, few seek treatment as they are hesitant to discuss the problem with their partner or doctor. FSD can occur at all stages of life, though it becomes commoner with increasing age.

Lack of sexual drive is common in pregnant women, or in women going through a period of stress in their life. However, some women suffer from this all the time. Lack of desire could result from depression, relationship problems, fatigue, concern about sexual performance and a previous traumatic sexual experience. Certain medications may lead to diminished sexual desire. Alcoholism and drug abuse are other causes.

Religious taboos, sexual identity problems and lifestyle factors may also contribute to inhibited sexual desire. Similarly, physical conditions like diabetes or hormone disorders affect libido.

Testosterone is a hormone that is naturally produced in females. A drop in testosterone levels results in a lack of sexual drive and contributes to a decline in sexual arousal, genital sensation and orgasm.

The inability to reach orgasm (anorgasmia) can be a problem for some women and their partners. It can be caused by relationship problems and sexual abuse, which lead to guilt and anxiety. Psychosexual therapy can help in overcoming orgasm problems.

Research is also being carried out to investigate if certain medical conditions that affect nerve and blood supply to the clitoris could cause anorgasmia.

Dyspareunia is when a woman experiences pain during sex. It is common during menopause when the drop in the oestrogen levels makes the vagina dry, leading to poor vaginal lubrication. This may affect a woman’s desire for sex. Such problems can be alleviated by medical treatment, such as hormone replacement therapy.

Endometriosis, ovarian cysts, vaginitis, cystitis, sexually transmitted diseases and scars from previous surgery or childbirth may all cause dyspareunia. Another cause is vaginismus, which occurs when the muscles surrounding the vagina involuntarily go into spasm leading to pain during intercourse. Counselling, sex education and vaginal trainers (cylindrical shapes inserted into the vagina) can be used to overcome vaginismus.

FSD can be treated and it is important that a woman talks about this problem with her gynaecologist. The doctor will thoroughly evaluate symptoms and assess sexual and medical history. Tests are carried out to exclude underlying medical conditions, including pelvic examination and Pap smears. The doctor may also recommend the help of a trained therapist as both physical and psychological problems need to be addressed to successfully treat FSD.

It is important that a woman discusses these problems with her partner and, ideally, her partner should accompany her when she visits the doctor and therapist for help.