Sexuality is a complex process that is coordinated by the neurological, vascular and endocrine systems. Sexuality incorporates family, societal and religious beliefs. It can be altered by aging, health status and personal experience. Sexual activity incorporates interpersonal relationships. Each partner of a sexual relationship brings unique attitudes, needs and responses to the relationship. A breakdown in any of these areas may lead to sexual dysfunction.
Sexual dysfunction includes desire, arousal, orgasmic and sex pain disorders that include dyspareunia and vaginismus. In women sexual dysfunction is more complex than that of male sexual dysfunction. A womans lack of sex drive is greatly intertwined with many aspects of life. The estimates of the number of women who have some form of sexual dysfunction ranges from 19 to 50 percent in what is referred to as a “normal out-patient population”. These numbers increase to 68 to 75 percent when sexual dissatisfaction or problems that are not dysfunctional in nature are included. The problems range from not being able to have orgasms to having no sexual desire at all.
Having low to no sexual desire is referred to as hypoactive sex drive or HSD. By definition women with HSD lack sexual fantasies, suddenly find sex uninteresting and rarely masturbate. Women with HSD may not feel deprived of sex, but the lack of libido causes stress. One of the biggest stresses for women with sexual dysfunction is worrying about the inability to satisfy their husband’s needs.
There are many factors that could be sources of sexual dysfunction. If diagnosis is to be made, it is important to locate the possible source. One of the biggest factors is medications. Medications may include those for blood pressure and diabetes. Other medications include antidepressants, tranquilizers, appetite suppressants, chemotherapy for cancer, over-the-counter medications and opioids. Other sources include long-term medical diseases, minor ailments, psychosocial difficulties that include prior physical or sexual abuse, gynecological maladies and cancers that include breast cancer. Illicit drugs, cigarette smoking and alcohol abuse are also significant factors.
The diagnosis requires the physician to obtain a detailed patient history that defines the dysfunction, identifies causative or confounding medical or gynecological conditions and elicits psychosocial information. Diagnosis also requires the establishment of the patients sexual orientation. Preappointment questionnaires are helpful in obtaining all the needed information without time constraints or the patients fears of the upcoming physical examination.
There are currently no FDA approved medications to treat female sexual dysfunction. There are several paths being studied and they include the stimulation of certain molecules or receptors in the brain and increasing the blood flow to the genitals. One medication is FDA approved for the treatment of male sexual dysfunction. This medication is Sidenafil. It is better known as Viagra. Studies show that Sidenafil could be an option of treatment for women as well. Although studies continue, Viagra has not yet been approved for the treatment of female sexual dysfunction.
Although there are no FDA approved medications there are medications and treatments available for female sexual dysfunction. Creams that are available include Estrace and Premarin. Medications in pill form include Premarin that is also available in injections, prempro and premphase and Estratest. Other treatments include EROS-CTD, a clitoral therapy device and Evista, a selective estrogen receptor modulator (SERM). These medications and treatments are all available with a doctors prescription. There are currently many other medications and treatments, but they are still in the clinical trial phase.
The highest proportion of female sexual dysfunction occurs in women between the ages of 18 and 29. The lack of desire appears to be the number one most significant complaint and is followed by arousal and lubrication dysfunction. The prevalence of female sexual dysfunction continues to be documented and it has generated discussions among the medical and lay communities. Although in the past female sexual dysfunction has been virtually ignored, the demands of women are now being heard and more studies are being done in order to better treat female sexual dysfunction.