Female Sexual Dysfunction

Roughly half the world’s population is female so it is worthwhile to understand the factors that determine good female sexuality, what some of the difficulties are and what can be done about them.

In general, women only have a relatively small amount of the libido hormone testosterone so that sexual interest and behaviour may be significantly influenced by personal wellbeing, relationship dynamics, context of the sexual activity, appropriateness of the sexual behaviour, sexual beliefs and sexual education. Women may be more affected by negative factors such as lack of time, fatigue, anger and resentment and lack of intimacy than men.

Among younger women lack of sex education and experience, shyness and insecurity about their bodies and lack of assertiveness may be major contributors to difficulties. Later, tiredness, poor relationships and anger become more relevant and then with menopause, hormonal factors, health issues, longevity of the relationship and partner health and sexual function issues become significant. However, each woman and each couple are unique in how contributory factors come together and play out.

The main female sexual difficulties are:

  1. Inhibited sexual desire and desire discrepancy in the couple
  2. Orgasmic difficulties
  3. Vaginismus and pain disorders
  4. Body dysmorphic disorders

Management of each of these difficulties requires specific strategies based on understanding the individual’s sexual, psychological and relationship history.

Inhibited sexual desire has to be evaluated understanding the broad range of normal female sexual desire which at one end may be that the woman is responsive to a male on a few occasions early in the relationship adequate for impregnation. And at the other end is the woman who wants and is initiatory daily. Nature is not particularly interested in recreational sexual activity. In the desire discrepancy situation both partners may be sexually, medically and psychologically normal and it is the difference between them that is the “patient”.

Orgasmic difficulties mainly require behavioural sexual techniques and encouragement to overcome inhibitory behaviours. The vast majority of women are capable of reaching orgasm given the opportunity to discover their individual pathway. While synchronous multi-orgasms may not be achievable by everyone it is always possible to improve one’s experience.

Pain disorders/dyspareunia need to be properly medically evaluated and relevant causes treated, before corrective behavioural and psychological therapies are instituted. Vaginismus needs a very empathic history and then supportive behavioural sex therapy. Optimally, the partner should be included in the management and his needs also considered.