Have you ever struggled to orgasm? Maybe sex is painful for you? Or maybe you used to have a high libido and now you barely want to have sex with your partner and you don’t know what has gone wrong?
Before we go any further, I must let you know that you that you are not alone!
Studies have found that up to 43% of women have complaints relating to their sexual functioning during their lifetime. The real problem is that most women don’t end up reporting it, and it lands up going unrecognised for years.
Whether this is because of embarrassment or shame or just a general discomfort with the topic, sexual problems are often not addressed in the doctor’s consultation room.
*For the purposes of this blog post, we will be talking about sexual dysfunction occurring in vulva owners.
What is female sexual dysfunction?
Female sexual dysfunction is when a vulva owner has a persisting or recurrent problem that occurs during the sexual response cycle that prevents them from experiencing satisfying sex. This can be problems with sexual interest or desire, arousal and lubrication, difficulties with orgasm, or painful sex.
It is also common to experience more than one problem with sexual functioning at the same time.
When should we worry?
And the answer is: When it starts to worry you! If your sexual function (or lack thereof) starts causing you distress and starts causing difficulty in your relationships, then it is time to reach out for help.
When it reaches this point, we can start calling it sexual dysfunction.
How common is it for women to have sexual problems?
A large study was done in the US called the Prevalence of Female Sexual Problems Associated With Distress and Determinants of Treatment Seeking (PRESIDE). This study found that the prevalence of women reporting problems with their own sexual functioning was 43.1%, but the prevalence of actual distress associated with these sexual problems was only 12%.
The distinction between having a sexual problem and having associated distress is important.
Sexual function is an incredibly subjective experience. Therefore, only you can decide whether you have a problem which needs addressing, or you are going through a phase in your life where sex just isn’t a priority for you . Nobody else can make that decision for you.
In the study, they found that the most common type of sexual problem reported was a lack of sexual desire, followed by problems with arousal. Similar results have been found in other studies.
I should note that it is very difficult to get accurate statistics about female sexual dysfunction due to the inherent nature of female sexual function itself. It is incredibly complex and multi-factorial.
The factors of sexual dysfunction.
Sexual problems are so prevalent because they can be caused by a wide range of different factors, ranging from biological factors to psychological and social factors. Often there is a combination of different factors at work at the same time.
Each one will need to be addressed individually and as a group.
What kinds of biological factors can affect sexual functioning?
- Biological factors can include pregnancy, childbirth, the postpartum period, menopause, medical conditions and medications.
- Common general medical conditions that can affect sexual functioning are: endocrine or hormonal disorders, vascular disease, neurological conditions, and inflammatory conditions like rheumatoid arthritis and inflammatory bowel disease.
- Other medical conditions specifically affecting the reproductive organs can cause problems, such as sexually transmitted infections (STIs), skin conditions of the genitals, bladder or uterine prolapse, incontinence, endometriosis, fibroids, cancer (of the breast, ovaries, or cervix) and chronic urinary tract infections.
An often overlooked area is whether any trauma has occurred to the reproductive organs, such as childbirth, episiotomy or pelvic surgery that can cause pain during sex.
When talking about biological factors, we cannot leave out the important lifestyle factors such as smoking, lack of physical activity, as well as drug and alcohol abuse. These factors are often underestimated but can make a huge difference if addressed.
Types of medication may negatively affect your sexual functioning.
Medications include: antidepressants, antipsychotics, narcotics, anticholinergics, antihistamines, antihypertensives, antiestrogens and oral contraceptive pills.
If you feel like the medication you are taking is disrupting your sexual functioning, please make sure to speak to your doctor about it. It may be possible to change the medication to something else with fewer side effects. Never just stop your medication without consulting your doctor first.
If you would like to have a deeper look at which specific medications can affect your sexual functioning, I have compiled a medication cheat-sheet that you can download HERE.
Psychological factors play A HUGE role in sexual functioning.
It’s true what they say, “the brain is our most important sex organ!”
Psychological factors should never be left out, and they may include previous sexual assault or trauma, depression, anxiety, OCD, acute life stressors and body image concerns.
Social factors also fall into this area and can make a big difference in how you approach sex in the first place, such as a lack of sex education, your cultural norms, your religious influences, and any negative attitudes you may have towards sex.
Your relationship with your partner/s is important too.
If your relationship is in a difficult place or you are not connecting with your partner, sexual problems can sometimes be the first sign that something is not right.
Conflict with partners, lack of emotional intimacy and difficulties with communication can manifest in the bedroom. If it is not addressed, it can lead to a cycle of more sexual problems leading to more conflict, leading again to more sexual problems.
If this is something that you are struggling with, consider seeing a therapist in your area that has experience with couple’s therapy. They can help you get to the root of the problem and improve communication and connection in the relationship.
How is female sexual dysfunction diagnosed?
Sexual dysfunction needs to be addressed by a medical doctor first, in order to rule out any possible biological or physical causes for the problem.
During the consultation, the healthcare provider may ask detailed questions about your sexual functioning and how it has changed. They may ask about your symptoms, any medical conditions you may have, and whether you are using any medications.
They may dive deeper and ask a little more about your mood, past sexual experiences and your current relationships.
A physical examination is usually done to rule out certain medical conditions, especially if there is a concern about sexual pain.
There is a questionnaire that can be used to measure sexual functioning in women. It is called the Female Sexual Function Index (FSFI) and it is usually the tool used in research studies. It has questions addressing your levels of sexual desire, arousal, sexual satisfaction, as well as the quality of orgasms and sexual pain.
What happens if I’m really struggling with my sexual function but I can’t find any cause?
From a more psychological perspective, there are three types of female sexual dysfunctions recognised by the DSM 5.
The DSM 5 (Diagnostic and Statistical Manual of Mental Disorders 5th Edition) is the handbook used by psychiatrists and psychologists as a guide for the diagnosis of mental health disorders.
The three types include: female sexual interest/arousal disorder, female orgasmic disorder and genito-pelvic pain/penetration disorder.
These diagnoses are used only after every other identifiable cause has been ruled out, as discussed above. The problem also needs to have caused significant distress or interpersonal problems for you to qualify for this kind of diagnosis.
I’ll elaborate a little more on each one below.
Female sexual interest/arousal disorder.
Female sexual interest/arousal disorder is a sexual dysfunction where the problem is focused more on a lack of sexual interest or desire. The features include reduced or absent:
- interest in sexual activity.
- sexual/erotic thoughts or fantasies.
- initiation of sexual activity and responsiveness to partners attempts to initiate sexual activity.
- sexual excitement/pleasure during sexual activity.
- sexual interest/arousal elicited by internal or external stimulation.
- genital or non-genital sensations during sexual activity.
These features need to be present for at least 75% of sexual encounters for at least six months for this diagnosis.
Female orgasmic disorder.
Female orgasmic disorder is a dysfunction where, as the name implies, the focus is on problems with orgasm.
- Significant delay, infrequency or absence of orgasms during sexual activity, or
- Significantly reduced intensity of the orgasmic sensation during sexual activity.
We must specify that by “sexual activity” I mean all types of sexual stimulation, including internal and external stimulation. These features need to be present for at least 75% of sexual encounters.
Genito-pelvic pain/penetration disorder.
Genito-pelvic pain/penetration disorder is a sexual dysfunction where the focus is on problems with sexual and genital pain when it comes to penetration. Vaginismus falls under this category too.
The features include persistent or recurrent difficulties with at least one of the following:
- Vaginal penetration during intercourse.
- Significant vulva, vaginal or pelvic pain either during intercourse or during attempted penetration.
- Significant fear or anxiety about the potential for vulva, vagina or pelvic pain prior to, during, or as a result of vaginal penetration.
- Significant tensing or tightening of the pelvic floor muscles during attempted penetration.
Each of these dysfunctions can be present from the time of first becoming sexually active or acquired later on after a period of no sexual problems or concerns. They can also be present all the time, or only in certain situations.
I think I have a sexual problem, what do I do next?
If you have any concerns about your sexual functioning, it is important to speak to your doctor first. Depending on your country, usually you start by visiting your local GP or primary care doctor, if they cannot help you, then they must refer you to the appropriate specialist so that you can get the help you need.
Because sexual functioning is so complex and multi-factorial, we usually use a multidisciplinary approach to address any areas of concern. What we mean by that is that each problem is addressed by a team consisting of a medical doctor, a psychologist or sex therapist, a physiotherapist and a sex educator.
The treatment plan will then depend on the areas of concern and any particular causes identified. Each treatment plan is personalised to the individual and will vary from person to person.
Sexual complaints by women are incredibly common and can be caused by a wide range of factors, including medical conditions, medications, psychological issues, as well as social and relationship problems.
To make all of these factors a little easier to remember, we can think about it another way – Everything contributing to adequate sexual functioning can be a potential cause for dysfunction if something goes wrong.
The key is to recognise when these concerns are becoming a problem for you or start interfering with your relationships.
If you have any concerns related to your sexual functioning, it is important to bring up the topic with your doctor. If you find that your doctor is unable to help you, make sure they refer you to someone who can, such as a sexual health physician or sexual medicine specialist, or a certified sex therapist.
This is not a problem that you need to struggle with for the rest of your life. There is help available for you.
Did you find the read interesting? Explore our library of articles about women’s sexual health. Partnering with sex therapists and the medical community, we go beyond creating sensual products for women, and aim to cover all aspects of female sexuality: body and mind!
Dr Megan Martin is a medical doctor and sexual health blogger. Her passion for empowering women to make informed decisions about their own sexual health and well-being flows through in the science-backed online education she provides. Megan teaches women how to have the sexual relationships they deserve. When she’s not saving lives, Megan is usually reading the kinds of books you’d rather keep hidden from your mother.
Megan is a member of the Southern African Sexual Health Association and has been nominated as one of 120under40 International Family Planning Leaders for 2019.
- Hayslett, R.L, Nykamp, D. Sexual Dysfunction in Women. US Pharm. 2015;40(9): 46-49.
- Clayton, A, Juarez, E.M.V. Female Sexual Dysfunction. Psychiatric Clinics of North America. 2017;40(2): 267-284.
- Khajehei, M, Doherty, M, Tilley, P.J.M. An update on sexual function and dysfunction in women. Arch Womens Ment Health. 2015;18(1): 423-433.
- Wright, J.J, O’conner, K.M. Female Sexual Dysfunction. Medical Clinics of North America. 2015;99(3): 607-628.
- L Shifren, Jan & U Monz, Brigitta & A Russo, Patricia & Segreti, Anthony & Johannes, Catherine. (2008). Sexual Problems and Distress in United States Women. Obstetrics and Gynecology. 112. 970-8.
- Chen, C, Lin, Y, Chiu, L. Female sexual dysfunction: Definition, classification, and debates. Taiwanese Journal of Obstetrics and Gynecology.2013;52(1): 3-7.
- American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association
- Shifren, J.L, Monz, B.U, Russo, P.A. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112(5): 970-978.
- Chedraui, P, Perez-lopez, F.R. Assessing sexual problems in women at midlife using the short version of the female sexual function index. Maturitas. 2015;82(3): 299-303.
- Zhang, C, Tong, J, Zhu, L. A Population-Based Epidemiologic Study of Female Sexual Dysfunction Risk in Mainland China: Prevalence and Predictors. Journal of Sexual Medicine. 2017;14(11): 1348-1356.
- Moreau, C, Kagesten, A.E, Blum, R.W. Sexual dysfunction among youth: an overlooked sexual health concern. BMC Public Health. 2016;16(1): 1170.
- McCabe, M.P, Sharlip, I.D, Lewis, R. Incidence and Prevalence of Sexual Dysfunction in Women and Men: A Consensus Statement from the Fourth International Consultation on Sexual Medicine 2015. Journal of Sexual Medicine. 2016;13(2): 144-152.
- Wolpe, R.E, Zomkowski, K, Silva, F.P. Prevalence of female sexual dysfunction in Brazil: A systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2017;211(1): 26-32.
- Atlantis, E, Sullivan, T. Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis. Journal of Sexual Medicine. 2012;9(6): 1497-1507.