Dr. M Shaeed

Understanding and addressing female sexual dysfunctions

Whether the woman is willing to deliberately find or be receptive to sexual stimuli, depends on any factors that affect her motivation, many other factors will influence her arousability, notable the processing of sexual information in her mind. Both psychological and biological factors are involved they are inherently blended. External and internal stressors alter the immune system, neurological and hormonal physiology.If the woman becomes aroused and desires and she finds the state enjoyable, the arousal may increase in intensity and she senses a need for sexual satisfaction. If the outcome is positive both physically and emotionally, future sexual motivation is increased. This type of cycle underscores the biopsychosocial nature of sexual function of a woman and thereof dysfunction which is important for understanding the potential treatment protocols in female sexual dysfunctions.

Since it is impossible to specify with any degree of precision when a â sexual problem or complaint should be diagnosed as dysfunction, it is crucial that the clinics judgment be taken into account in addition to the womens report of distress. Contextual and interpersonal factors must be considered in order to make a complete diagnosis.

Importance of addressing sexual complaints with a physician

sexual complaints may be the result of:

• medical conditions
• medications with sexual side effects
• psychological and interpersonal issues

Intimacy based female. Sexual response cycle

So what is female sexual dysfunction?

Female sexual dysfunction involves any problem from any phase of sexual response cycle that prevents an individual or couple from experiencing satisfaction from sexual activity. It includes disorder of desire, arousal, orgasm and pain.

Categories of female sexual dysfunction

• Prevalence of female sexual dysfunction
• Fsd risk factorshypertension
• smoking & substance abuse
• hyperlipidemia
• previous pelvic surgery
• past psychological trauma

Causes of female sexual dysfunction

Medication that may adversely affect sexual function

Certain medical conditions can increase the risk

• Condition-effects on sexual function
• depression-decreased desire
• diabetes-impaired arousal and orgasm
• thyroid disease-decreased desire
• cardiovascular disease-impaired arousal
• neurologic diseases-impaired arousal and orgasmâ 
• androgen insufficiency-decreased desire 
• estrogen deficiency- impaired arousal

Comprehensive sexual assessment

• Nature of problem
• duration of problem
• primary or secondary
• situational or generalized
• relationship problems
• stressors
• sexual problems in partner
• history of physical, emotional, or sexual abuse

General treatment guidelines

• Education -anatomy, sexual function, effects of pregnancy, menopause & aging
• enhancing stimulation -erotic materials, encouraging communication during sexual activity
• distraction techniques - fantasy, kegel exercises with intercourse, background music or television
• encouraging non-coital behaviours, sensate focus exercise
• minimize pain - positional, lubricants, warm baths,biofeedback, prior to  intercourse
• treatment depends on the cause, if organic, appropriate medical/surgical interventions along with sex counselling. If psychogenic  then¨psychotherapy/sex therapy/ marital therapy or cbt can be used.
• lifestyle modification should be included in all cases.

Determinants of sexual desire in women

• reproducible measurement devices and instruments for evaluating physiological female sexual response
• clinical trials of vasoactive agents ¨and other medical treatments
• physician awareness and competency in female sexual dysfunction

Treatment option on the horizon

• androgens
• prostaglandins
• nitric oxide delivery systems
• dopamenergic agonist
• flibanserin (addyi)
• drugs useful for reducing pain in¨sexual pain disorder (gabapentin)

Holistic approach for management

Most successful treatments for fsd are psychophysiological, physiological change circularly interacts with  psychological change. The many psychological factors that motivate a woman to begin her sexual experience must always be kept in the forefront.Since a psychological treatment does impact sexual physiology,we need to continue to develop psychological approaches for intellectual interest and out of respect for the choices of patients preference.Prescription of a physiological treatment which ignores the ¨fact that human sexuality is infused with individual meaning may invite further interference with sexual functioning.