Female Sexual Dysfunction (FSD)

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What is Female Sexual Dysfunction?

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The World Health Organisation defines female sexual dysfunction (FSD) as “the various ways in which an individual is unable to participate in a sexual relationship…she would wish.” FSD is classified into a range of disorders depending on the specific nature of the sexual difficulties a woman encounters. They are:

Hypoactive sexual desire disorder: The persistent or recurrent lack of sexual fantasies, thoughts, desires and receptivity to sexual contact.
Sexual aversion disorder: The persistent or recurrent fear and/or aversion of sexual contact.
Sexual arousal disorder: The persistent or recurrent inability to become sexually aroused, often characterised by inadequate vaginal lubrication for penetration.
Orgasmic disorder: The persistent or recurrent inability to orgasm.
Dyspareunia: Pain during sexual intercourse.

Women suffering from FSD become anxious or distressed about being unable to engage in or experience sexual activity as they wish. However, other women may experience sexual difficulties (e.g. inability to orgasm) which do not cause them distress. These women do not have FSD. Amongst women with FSD, hypoactive sexual desire and orgasmic disorders are the most commonly reported.

There are many physical causes of FSD and these are mainly related to hormone levels and changes. However, FSD is most commonly the result of psychological factors (e.g. relationship satisfaction, depression). Even when FSD is the result of physical factors, psychological factors often contribute to the problem (e.g. women who have difficulty achieving adequate vaginal lubrication or find sex painful may become anxious about approaching sexual encounters, and find it even more difficult to lubricate).

Who gets Female Sexual Dysfunction?

Female sexual dysfunction Research suggests that the majority of women experience sexual dysfunction at some point in their lives, and for many it is an ongoing or recurring issue. A large survey of Australian women reported that 70% had experienced sexual difficulties (including inability to orgasm and not feeling like sex) in the year before the survey. Women over 50 were most likely to experience sexual difficulties, although they were common in all age groups (over 60% of women aged over 50 reported lack of interest in sex, and more than half of women aged 16-49 also reported this difficulty).

Survivors of sexual assault often experience difficulties in future sexual relationships, which may bring back difficult memories of incidents of assault. Women who are pregnant, have recently given birth or are breastfeeding are more likely to experience sexual dysfunction than those who are not. Hormonal imbalances and psychological factors both play a role for these women.

Women also often experience sexual dysfunction following menopause, which is mainly a result of hormonal imbalances.

Sexual dysfunction associated with cancer

Between 10 and 88% of patients diagnosed with cancer experience sexual problems following diagnosis and treatment. The prevalence varies according to the location and type of cancer, and the treatment modalities used. Sexuality may be affected by chemotherapy, alterations in body image due to weight change, hair loss or surgical disfigurement, hormonal changes, and cancer treatments that directly affect the pelvic region.

Sexual problems are reported in many patients with breast and gynaecological (e.g. cervical or vulval) cancer. They are also reported in patients with cancer that does not directly effect sexual organs, including lung cancer (48% of patients), Hodgkin's disease (50%), and laryngeal (60%) and head and neck cancers (39-74%).

For more information, see Sexual Difficulties Associated with Cancer in Women.

Predisposing Factors

While sexual dysfunction is wide spread in Australia, it is more common in particular groups of women. Factors associated with sexual dysfunction in women include:

History of sexual assault, rape or sexual coercion. This may be linked to post-traumatic stress disorder
Pregnancy
Childbirth in the past year
Breastfeeding
Menopause
Urinary incontine
Vaginal prolapse
Coronary heart disease
Hypertension, and hypertension medications
Cancer
Spinal cord injury
Depression, and antidepressant medications
Relationship problems
Stress
Fatigue
Previous gynaecological surgery, including hysterectomy and vault prolapse surgery

It is uncertain how they influence sexual function, but you may also have an increased risk if FSD if you have:

Previous posterior vaginal repair
Diabetes mellitus
Oral contraceptive use

Progression

Hormonal changes, which are the most common physical cause of FSD, tend to occur during and after childbirth and following menopause. Certain medications (e.g. antidepressants, hypertension medication) can also alter hormone levels. FSD is more common in women who take these medications.

Unlike in men, sexual dysfunction in women is most commonly the result of psychological factors which can arise throughout life. There is an immense amount of pressure on women in their roles as employees, wives and mothers. This can lead to stress, anxiety and fatigue, which are all more common in women who suffer from FSD than in those who do not. Women who are not satisfied with their relationships more commonly report FSD, as do those who are depressed.

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