Female Sexual Dysfunction
Female sexual dysfunction (FSD) is an “umbrella” term used for a range of diagnoses that affect female identity, sexuality, quality of life, and mental and physical health. It is both a challenging and exciting time for patients and health care providers interested in this field, as it is evolving in many aspects; from understanding the cause to establishing management and treatment. It is clear however, that (1) female sexual dysfunction is a significant problem as up to 43% of women may experience this condition, (2) sexual function is an important determinant in overall female pelvic health, and (3) when it decreases a patient’s quality of life, female sexual dysfunction should be recognized, addressed, and managed.
There are four major categories of female sexual dysfunction: sexual desire disorders, sexual arousal disorder, orgasmic disorder, and sexual pain disorders. The sexual desire disorders include hypoactive sexual desire disorder and sexual aversion disorder. The sexual pain disorders include dyspareunia, vaginismus, and noncoital sexual pain disorder. An important requirement in making the diagnosis of FSD is that the condition causes “personal distress.” In another words, if the patient is not bothered by her condition, then by definition, it is not a problem.
Definitions
Hypoactive sexual desire disorder is the persistent or recurrent deficiency (or absence) of sexual fantasies/thoughts, and/or desire for or receptivity to sexual activity, which causes personal distress.
Sexual aversion disorder is the persistent or recurrent phobic aversion to and avoidance of sexual contact with a sexual partner, which causes personal distress.
Sexual arousal disorder is the persistent or recurrent inability to attain or maintain sufficient sexual excitement, causing personal distress, which may be expressed as a lack of subjective excitement, or genital (lubrication/swelling) or other somatic responses.
Orgasmic disorder is the persistent or recurrent difficulty, delay in or absence of attaining orgasm following sufficient sexual stimulation and arousal, which causes personal distress.
Dyspareunia is the recurrent or persistent genital pain associated with sexual intercourse.
Vaginismus is the recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration, which causes personal distress.
Noncoital sexual pain disorder is recurrent or persistent genital pain induced by noncoital sexual stimulation.
Every complete evaluation begins with a thorough history and physical examination, usually in a physician’s or health care professional’s office with special training, expertise, and/or interest in female sexual function. At the Center for Sexual Health, we encourage presence of the partner at the evaluation, as we believe the state-of-the-art approach to management and treatment of female sexual dysfunction is couple-based. Although the partner may not be physically present at the appointment, it is critical to have an involved partner (partner participation). The diagnostic testing of female sexual dysfunction is dependent upon the symptoms and signs of the individual patient. In addition to the history and physical examination, other diagnostic testing may include:
Self-Administered Questionnaires – used to understand baseline characteristics of patients/couples as well as assess effectiveness of therapy. The Female Sexual Function Index (FSFI) is commonly used.
Hormone evaluation – blood work to check for hormone imbalances, especially in cases of decreased libido, or desire.
Urodynamics – where a catheter is placed inside the bladder to measure the bladder reaction to slowly being filled with fluid. The test assesses urinary incontinence, rectal tone, and pelvic nerve function.
Genital Sensory Analyzer – vaginal probe is inserted to measure temperature, vibratory stimulation, and pressure to assess neurological function.
Bladder Ultrasound – non-invasive test to measures how much urine is left in your bladder after voiding.
Flexible Cystourethroscopy – lighted telescope with water running through it, is inserted into the bladder to visualize any bladder abnormalities, such as mucosal lesions, stones, tumor growths, source of bleeding, and potential source of urinary tract infections.
At the Center for Sexual health, we take an integrated, comprehensive, couple’s approach to the management and treatment of sexual dysfunction. The management of female sexual dysfunction would not be complete without addressing the partner. If the partner is a male, please visit couple’s sexual health for more information.
Our center has gathered a team of experts in their individual fields to provide an integrated multidisciplinary approach to optimize the management and treatment of the couples suffering from female sexual dysfunction. The complete medical assessment is performed by a board-certified urologist. We are affiliated with an obstetrician-gynecologist, a physical therapist with a special interest in female pelvic health and rehabilitation, and a therapist with expertise in individual and couples’ counseling. In addition, we have highly trained, compassionate medical assistants and support staff to optimize your experience in seeking management and treatment.
