What causes sexual dysfunction?
When the dysfunction follows a period of adequate sexual functioning, doctors and sex therapists find that a lack of sex drive is often tied to a woman’s relationship with her partner. Other psychosocial causes include family concerns, illness or death, financial problems, job worries, chronic anxiety, childcare responsibilities, trying to balance career with children, religious or cultural beliefs, unresolved sexual orientation, previous traumatic sexual experience, including rape, a history of physical, sexual or emotional abuse.
Female sexual dysfunction can also be physically rooted. Causes include fatigue, depression, high blood pressure, hormonal insufficiency, heart disease, cancer, diabetes, hypothroidism, adrenal insufficiency, neurological diseases such as multiple sclerosis, localized disorders such as vaginal yeast infections, cystitis, endometriosis, and vaginitis, chronic liver disease, breast-feeding, recovery after childbirth, autoimmune disorders, and prescription drugs for high blood pressure, depression and anxiety. Other prescription drugs, over-the-counter medications, illegal drugs, and alcohol abuse can also cause sexual dysfunction.
One of the most common physical causes of sexual dysfunction is vaginal dryness due to menopausal changes. Decreased estrogen may cause the vaginal walls to become drier and thinner or women may have less interest in sex, slower arousal time or discomfort and pain during intercourse.
Searching for a cause is not simple. A woman’s sex drive is a complex interaction of signals between the brain, ovaries, other reproductive organs, and emotions. Beliefs, experiences, lifestyle and relationship play an equally important role.
Although visual cues tend to play an important role in erection, intercourse, and orgasm in men, an emotional connection to her partner plays a larger role in desire, arousal, and satisfaction in women.
For women in their 30s and 40s, the demands of career and family can make sex feel like one more thing on their to-do list.
How is sexual dysfunction diagnosed?
Sexual dysfunction in men, which is sometimes referred to as impotence, is a fairly well-known condition. This may be because men experiencing sexual dysfunction are often unable to have sex. Women with sexual dysfunction, on the other hand, are still able to have sex but they are uninterested or don’t fully enjoy it.
Women experiencing sexual dysfunction should consult a physician. Depending on the medical and social history, the following may be performed:
physical exam
pelvic exam
screening tests for depression
complete blood count
urinalysis
blood test to measure follicle-stimulating hormone (FSH)
blood test to measure luteinizing hormone (LH)
serum estradiol test to assess estrogen levels
serum testosterone levels
cultures of the vaginal discharge
What are the long-term implications of sexual dysfunction?
Sexual dysfunction may cause poor self-esteem and a sense of failure, which may lead to chronic depression and anxiety.
Conventional Treatments
Physical disorders should be treated. Couples should try to discuss the matter openly, so they can identify the problems and solutions and strengthen the emotional bonds that can improve their sexual relationship.
Counseling can help with larger issues, like a mismatched sex drive or orgasm troubles. Counseling can also ease the anger and resentment that can interfere with satisfying sex.
A woman and her partner should understand the functioning and responses of female sexual organs, including the best methods of stimulating the clitoris and enhancing vaginal sensations.
Kegel exercises strengthen voluntary muscles of the pubococcygeus in the pelvis. The muscle is contracted 10 to 15 times, three times a day. The sensation is of contracting the pelvic floor muscles as if you are trying to stop the flow of urine. In two to three months, the muscles around the vagina improves.
Viagra is designed to increase blood flow to the genitals. Viagra works well for many men who suffer with impotence—or erectile dysfunction—due to a physical cause. Initially, viagra was believed to help the 20 percent of women reported to have difficulties with lubrication (blood flow to the female genitals increase lubrication). But it doesn't appear to give women the same boost it gives men. Studies show the drug is no more effective than placebo in women.
Testosterone, the male sex hormone, is a promising treatment. Women produce testosterone in their ovaries and adrenal glands. In women, testosterone levels peak during her 20s and then decline slowly with age. Clinical studies have found that high doses of testosterone can increase sexual pleasure and satisfaction. But side effects include worsening cholesterol levels and liver function. Acne, and excess of body hair, and deepening voice are also common.
A testosterone patch, which people believe to be a safer and still effective option for women with low testosterone levels, is awaiting approval by the Food and Drug Administration (FDA). In one clinical study of women with their ovaries removed, women who received testosterone patches reported 30 percent more satisfying sex than women who received placebo patches. Sexual desire also increased. Estratest is an oral prescription medication that combines estrogen and testosterone. Although it was approved to treat estrogen-resistant hot flashes, it is also prescribed by doctors for low libido.
There are natural methods to address sexual dysfunction in women. Please read the follow-up article which explains natural remedies and treatments.
Natural Treatments
Gingko
Gingko biloba is a herb that has been used for centuries in Traditional Chinese Medicine as a natural treatment for respiratory conditions, cognitive impairment, and circulatory disorders. In the west, it's popular use is to improve cognitive function and memory in people with age-related cognitive decline and memory loss. There have been a number of case reports and preliminary studies suggesting that it may be an effective treatment for antidepressant-induced sexual dysfunction or sexual dysfunction related to poor circulation.
Gingko for sexual function was first investigated after an older man who was coincidentally experiencing sexual dysfunction caused by antidepressant use, decided to take ginkgo to improve his memory. His sexual function improved so dramatically that it caught the attention of researchers. Subsequent investigation found that it has benefits for sexual dysfunction in both men and women.
An open clinical trial of Ginkgo biloba extract with 63 patients was found to be effective in 84% of patients with antidepressant-related sexual dysfunction. In the study, all phases of the sexual response cycle improved, including desire, excitement, and orgasm. Minimal side effects were reported which included gastrointestinal upset, headache, CNS stimulation and easy bruisability.
A recent two month double-blind, placebo-controlled study, however, found no difference between ginkgo and placebo at 2 weeks, 4 weeks, and 8 weeks. More controlled studies are needed.
Gingko should only be used under supervision. It is a blood-thinner that can increase the risk of bleeding and hemorrhage, especially when it is combined with blood-thinning drugs such as warfarin, heparin, and aspirin or nonsteroidal anti-inflammatory agents. People with clotting disorders should not take ginkgo. It can also interact with natural blood-thinners such as vitamin E.
Arginine
Arginine is an amino acid, also referred to as L-arginine. It is one of the more popular supplements for sexual dysfunction. Arginine is needed by the body to make nitric oxide, a compound that works through cGMP to relax blood vessels and allow more blood to flow through arteries.
Double-blind, placebo-controlled studies on arginine in women are required. One preliminary double-blind study found some evidence that a combination treatment including arginine could benefit women. In a four-week, double-blind study, 77 women with decreased libido were given either a combination product or placebo. Women taking the arginine product showed greater improvement such as increased reported sexual desire in 71% compared to 42% in the placebo group. They reported other improvements such as improved satisfaction with sex life, improved frequency of orgasms, and improved clitoral sensation.
Yohimbe
Yohimbe bark (Pausinystalia yohimbe) was historically used for sexual dysfunction. It is a potentially dangerous herb and is not recommended for use, unless under close supervision by your physician.
DHEA
DHEA (dehydroepiandosterone) is a potent hormone produced naturally by the adrenal glands. It is converted in the body to both the female hormone estrogen and the male hormone testosterone. Levels of DHEA decline naturally with age and in cases of a condition known as adrenal insufficiency. Because both older people with a natural decline and people with adrenal insufficiency notice a drop in libido, several studies have examined whether supplemental DHEA can improve libido in these groups. Preliminary research suggests that it may help improve sexual function in women, although well-controlled studies are needed.
Physician supervision is strongly advised when using DHEA. Side effects include acne and male pattern hair growth. Even a low dose of 25 mg per day can decrease levels of good cholesterol. There have been conflicting reports linking DHEA to some types of cancer. DHEA is converted to other hormones in the body, so it may also affect hormone related diseases such as breast cancer. Safety of DHEA in young children and pregnant or nursing women has not been established.
Damiana
Damiana (Turnera diffusa) is a herb that was used traditionally by the Mayan people of Central America to enhance sexual function in men and women. It is reported to be an aphrodisiac, stimulant, mood elevator, and a tonic.
There has been little research on damiana. It is believed to increase testosterone levels.
St. John's wort
St. John's wort (Hypericum perforatum) is used as a herbal antidepressant that may be helpful for sexual dysfunction related to depression. It's effectiveness for mild to moderate depression has been substantiated by much research. Many people self-prescribe it hoping to lessen symptoms of depression without the use of prescription medications. People should work with a health professional when exploring their treatment options.
It's not clear how St. John's wort works, but it may have properties similar to conventional antidepressants such as SSRIs or MAOIs. It should not be combined with other antidepressants. In fact, it can decrease the effectiveness of many prescription drugs, such as heart medication, blood-thinners, oral contraceptives, antibiotics, and many other drugs.
Ginseng
Chinese ginseng root (Panax ginseng) and the North American ginseng (Panax quinquefolius) may improve sexual dysfunction such as anorgasmia and decreased libido in patients taking antidepressants.
The active ingredients, ginsenosides, are believed to facilitate the release of nitric oxide in blood vessels which may increase blood flow to the clitoris resulting in heightened orgasm.
Ginseng is known to possess phytoestrogen activity. The herb is believed to help the body adapt to stressful conditions.
Side effects may include hypertension, insomnia, vomiting, headache and epistaxis. Isolated case reports have noted post-menopausal vaginal bleeding and breast nodularity with prolonged usage, suggesting a modest estrogen-like effect. A two-year study of 133 people using ginseng noted a stimulant effect. Nervousness and insomnia were noted in 11% of subjects. Ginseng is not recommended for patients with bipolar disorder (manic syndrome) or psychosis.
