Female Sexual Dysfunction

Female Sexual Dysfunction, or FSD, affects 43% of American women.  FSD can be subdivided into four categories:

1. Desire disorders
2. Arousal disorders
3. Orgasmic disorders
4. Pain disorders

Libido Disorders

There are many factors that can decrease a women’s desire for sex, such as her overall health, fatigue, self-image, stress, and the quality of her relationship.   All of these factors must be considered when evaluating a women for FSD.

Arousal Disorders

Arousal disorders affect up to 31% of women with FSD.  When a woman is sexually aroused, she experiences increased blood flow to the genitalia and increased lubrication and physiologic changes to the vagina.  Although many women have the desire to have sex, they do not experience sexual arousal.

Orgasmic Disorders

Female orgasmic disorder can be defined as delay in or absence of attaining an orgasm following sufficient sexual stimulation and arousal, which causes personal distress.

Almost 20% of women are unable to obtain an orgasm.  Many women experience “situational orgasms” in which they can only obtain an orgasm in certain settings.

Pain Disorders

There are many causes of pain disorders, and these disorders are much more common in post-menopausal women.   A decrease in estrogen results in decreased vaginal lubrication and increased vaginal dryness.  Some other common causes of pain disorders, such as vulvar vestibulitis, are more difficult to treat, and many require surgical intervention.

An FSD evaluation consists of a detailed history and physical examination.  This also involves completing pre-clinic questionnaires for the patient and her partner.  Most women will have laboratory testing to evaluate her hormone levels as well as to look for other causes of FSD, such as hypothyroidism.   If indicated, some women will have specialized testing such as genital ultrasound or quantitative sensory testing.

We follow an algorithm for treating FSD which involves identification, education, modification, medical therapy, and surgery (in needed).

1. Treatment involves primarily identification of the problem, such as a desire disorders or pain disorders.  Identification of the problem is made through the history, physical examination, questionnaire responses, and laboratory and specialized testing.
2. After identifying the problem, we focus on educating the patient and her partner on female sexual dysfunction, the female anatomy, and the causes and treatments for the different types of sexual dysfunction disorders.
3. Many times modifications will have to be made in a women’s lifestyle (ie. diet, exercise, stress reduction) or in her medications.  Women may need to undergo biofeedback or relaxation techniques to improve their sexual function.
4. Medical therapy involves hormonal and non-hormonal treatments.  Hormonal treatments many include estrogen and/or testosterone replacement therapy. Non-hormonal treatments include medications such as Wellbutrin or certain natural herbs.
5. Surgical therapy is indicated in only a select group of women, particularly those who suffer from pain disorders.  Surgical procedures include labioplasty, vestibulectomy, and incontinence procedures.

If indicated, some women will require a referral to another specialist, such as a sex therapist, psychiatrist, or an endocrinologist.  We have designed a group of specialists all specially trained to treat the issues of female sexual dysfunction.

Treating the Couple

Dr. Khera believes that sexual dysfunction is a couple’s disease and the couple should be treated concurrently.  There is much data supporting this belief.   Among men with ED, 43% of their female partners will have FSD.  Conversely, among women with FSD, 29% of their male partners will have ED.

There have been numerous studies demonstrating that by simply treating one partner, you are indirectly treating the other partner.   For example, studies have shown that by treating men with Levitra, sexual function significantly improves in their female partners.  This improvement is without any intervention to the women except for treating their male partners.   Other studies have shown that female urinary incontinence increases the risk of a male partner having erectile dysfunction by 3 fold.   Further studies have demonstrated that by treating a women’s urinary incontinence, a male partner has a significant improvement in erectile function.   Sexual dysfunction is clearly a couple’s disease and both partners should be evaluated and treated in order to maximize therapy.