What causes sexual dysfunction in females?

The causes of sexual dysfunction in females may be due to psychological or physical factors.

Psychological causes are experiences that affect a woman's sexual development. For example, past negative sexual or other experiences may lead to low self-esteem, shame, or guilt. Emotional, physical, or sexual abuse during childhood or adolescence can teach children to control and hide emotions-a useful defense mechanism-but such inhibition can make expressing sexual feelings difficult later.

Early traumatic loss of a parent or another loved one may inhibit intimacy with a sex partner for fear of similar loss. Women with desire/interest disorders tend to be anxious, to have a low self-image, and to have mood instability even in the absence of an established medical mood disorder. Women with orgasmic disorder often have difficulty relinquishing control in nonsexual circumstances. A subgroup of women with dyspareunia and vulvar vestibulitis has high expectations of self and fear of negative evaluation by others.

Contextual psychological causes are specific to a woman's current circumstances. They include negative feelings or reduced attraction toward a sex partner (eg, due to the partner's behaviors or to a growing awareness of attraction to women), nonsexual sources of anxiety or distraction (eg, family, work, finances, cultural restrictions), concerns about privacy, and concerns about unwanted outcomes (eg, unwanted pregnancy, sexually transmitted diseases, inability to have an orgasm, erectile dysfunction in a partner).

Many factors can contribute to inhibited sexual desire, including hormonal changes, medical conditions and treatments, depression, pregnancy, stress and fatigue. Boredom with regular sexual routines also may contribute to a lack of enthusiasm for sex, as can lifestyle factors, such as careers and the care of children. The inability to become physically aroused during sexual activity often involves insufficient vaginal lubrication.

Orgasmic disorder can be caused by sexual inhibition, inexperience, lack of knowledge and psychological factors such as guilt, anxiety, or a past sexual trauma or abuse. Other factors include insufficient stimulation, certain medications and chronic diseases.

Pain during intercourse (dyspareunia) can be caused by a number of problems, including ‘endometriosis' (abnormally located inner lining of the womb), pelvic mass, ovarian cysts (abnormal swelling of the ovary), inflammation of the vagina (vaginitis), poor lubrication, the presence of scar tissue from surgery and a sexually transmitted disease.

Many other physical and/or medical conditions can cause female sexual dysfunction. These conditions include diabetes, heart disease, neurological disorders, hormonal imbalances, menopause, chronic diseases such as kidney or liver failure, alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressants drugs, can affect sexual desire and function. These were discussed earlier in this column few weeks ago (under erectile dysfunction in men).

How is female sexual dysfunction diagnosed?

Your doctor will begin with a physical examination and a thorough evaluation of symptoms. The doctor may perform a pelvic examination to evaluate the health of the reproductive organs and a Pap test to detect changes in the cells of the cervix (to check for cancer or a pre-cancerous condition).

He or she may order diagnostic tests to exclude any medical problems that may be contributing to the dysfunction. An evaluation of the person's attitudes regarding sex, as well as other possible contributing factors (fear, anxiety, past sexual trauma/abuse, relationship problems, alcohol or drug abuse, etc.) will help the doctor understand the underlying cause of the problem and make appropriate recommendations for treatment.

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