Female sexual dysfunction (FSD)

Female sexual dysfunction (FSD) is defined as disorders of arousal, orgasm, sexual desire and/or sexual pain which result in significant personal distress. Common names for these disorders include vaginismus, dyspareunia, hypoactive sexual desire disorder, and female orgasmic disorder.

FSD can be age-related; it is estimated that 40-50% of adult women have at least one or more manifestations of sexual dysfunction. These disorders may or may not have a negative effect of the quality of life or the health of the woman, but when they cause enough personal distress she will seek treatment. Unfortunately, most women with FSD do not seek treatment although there are treatments and options that can help.

This Center represents an overview of FSD. It is not intended to be a complete and comprehensive discussion of FSD. The American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) offers current diagnostic criteria for FSD. The DSM-IV classifies FSD into four categories:

hypoactive sexual desire disorder
female sexual arousal disorder
female orgasmic disorder and
sexual pain disorders or dyspareunia.
Diagnosis of FSD uses the APA framework; all of the above diagnoses include "marked personal distress or interpersonal difficulty" as an essential criterion for diagnosis. The above disorders can be life-long, acquired, generalized or situational. Sexual problems may be a symptom of diseases like depression, neurological disorders, genitourinary disorders, or endocrine disorders such as diabetes, menopause, metabolic syndrome, or cardiovascular disease. FSD symptoms can also be related to side effects of medication used for other conditions. Diagnosis of FSD can be a challenge for clinicians because of the lack of proven valid and reliable testing tools and the limited number of evidence-based studies concerning FSD. This is further complicated by the lack of distinctions between normal and abnormal and the fact that many women are reluctant to seek help.

The relationship of cardiac disease and FSD is similar to the relationship of ED and heart disease. The fact that the heart pumps blood to our vital organs is true in both men and women. If the blood is not getting to those organs or genitals, male or female, they will not function optimally. Women may experience decreased desire, decreased arousal, decreased ability to achieve orgasm and a lack of lubrication which can lead to painful intercourse. Studies have indicated that vascular insufficiency decreases the blood flow to the clitoral and vaginal areas, leading to decrease in lubrication, arousal disorders or dyspareunia. A decrease in pelvic blood flow due to diseases of the aorta or iliac vessels, or trauma to pelvic floor structures can cause smooth muscle fibrosis leading to vaginal dryness and painful sex (dyspareunia).

Uncontrolled hypertension and antihypertensive medications are both associated with decreased lubrication of the vagina, dyspareunia and orgasmic disorders. Among women who experienced a myocardial infarction, approximately 44% reported a decline in the frequency of sexual intercourse with 27% reporting total abstinence.Sexual arousal disorder is the most common sexual disorder in women following coronary artery bypass surgery.

In 1948, Kinsey reported that sexuality remains an important part of life for postmenopausal women and this has not changed since Kinsey reported it. Sexual activity in older persons may range from cuddling to sexual intercourse. The issue of FSD in older women will be more prominent as the baby boomers age. It was recently reported that 47% of women age 66-71 are sexually active and 28% of women older than 78 years are sexually active and want to remain that way. The number one reported rationale for the decline of sexual activity in older women is lack of a partner. Other factors that affect the sexuality of older women include partner's age and sexual function, atrophy of sex organs, decreased muscle tone, pain related to chronic illness, hypertension, diabetes mellitus, arthritis, ostomies, stroke and lack of privacy.