Laura Berman

Female sexual dysfunction: incidence, pathophysiology, evaluation, and treatment options

F sexual dysfunction is age-related, progressive, and highly prevalent, affecting 30% to 50% of women.1–3 Based on the National Health and Social Life Survey of 1749 women, 43% experienced sexual dysfunction.4 U.S. population census data reveal that 9.7 million American women aged 50 to 74 years self-report complaints of diminished vaginal lubrication, pain and discomfort with intercourse, decreased arousal, and difficulty achieving orgasm. Female sexual dysfunction is clearly an important women’s health issue that affects the quality of life of many of our female patients. Until recently, little research or attention has focused on female sexual function. As a result, our knowledge and understanding of the anatomy and physiology of the female sexual response and the pathophysiology of female sexual dysfunction is limited. Based on our understanding of the physiology of the male erectile response, recent advances in modern technology, and the recent interest in Women’s Health issues, the study of female sexual dysfunction is gradually evolving. Future advances in the evaluation and treatment of female sexual health problems are forthcoming.

SSI Prize Essay for Female Sexual Dysfunction—Clinical ‘Clinical evaluation of female sexual function: effects of age and estrogen status on subjective and physiologic sexual responses’

Introduction: 30–50% of American women complain of sexual dysfunction. Aging, menopause, and a decline in circulating estrogen levels significantly increase the incidence of sexual complaints. Evaluaton of physiologic components of the female sexual response has, in the past, been technically challenging and difficult to standardize. We describe methodology for evaluating physiologic and subjective components of the female sexual response in the clinical setting and determine the effcts of age and estrogen status on them.Methods: 48 women with complaints of sexual dysfunction were evaluated. Physiologic measurements include genital blood peak systolic velocity, vaginal pH, intravaginal pressure–volume changes (compliance), and genital vibratory perception thresholds. Measurements were recorded at baseline and following sexual stimulation. Baseline subjective sexual function was assessed using a Female Sexual Function Inventory. Age was then correlated with both physiologic and subjective sexual responses.Results: Sexual stimulation resulted in increased mean genital blood peak systolic velocity, vaginal pressure–volume, and vaginal pH measurements (P<0.05) in all women. Older women (ages 55–71 y) and menopausal women not on hormone replacement therapy had significantly lower physiologic response sexual complaints. Baseline subjective sexual function complaints included low arousal (67%), low desire (21%), difficulty achieving orgasm (92%), and pain or discomfort during and/or following intercourse (67%).Conclusions: Clinical evaluation of physiologic and subjective components of the female sexual response are possible using this comprehensive approach. Physiologic measurements were reproducible and easy to perform, and incidence and types of sexual complaints were assessed with the sexual function questionnaire. A comprehensive approach is necessary when evaluating female sexual dysfunction due to the significant emotional and relational factors that can contribute to the problem. This combined subjective/physiologic assessment may also prove useful when evaluating efficacy of pharmacotherapy in the future.

Female sexual dysfunction: anatomy, physiology, evaluation and treatment options.

It has been estimated that up to 76% of women, depending upon their age, have complaints of sexual dysfunction, including decreased libido, vaginal dryness, pain with intercourse, decreased genital sensation and difficulty or inability to achieve orgasm. Female sexual dysfunction is a significant problem that affects the quality of life of many women. This review addresses the etiologies and incidence of female sexual complaints, as well as new findings in the evaluation and treatment of female sexual dysfunction.

Novel approaches to female sexual dysfunction

Female sexual dysfunction is age-related, progressive and highly prevalent, affecting 30 - 50% of American women. While there are emotional and relational elements to sexual function, it has become increasingly evident that female sexual dysfunction can occur secondary to medical problems and has an organic basis. A plethora of different female sexual dysfunctions exist and in order to obtain a greater understanding of the possible treatments for these problems, it is essential to have a strong knowledge base of female pelvic anatomy, the neurogenic mediators of female sexual response, the impact of hormones on female sexual function and the aetiologies of female sexual dysfunction. Currently, there are potential therapeutic options for the treatment of female sexual dysfunction and these options include both hormonal and pharmacological therapy. However, therapeutic agents may not prove to be enough and the ideal approach to female sexual dysfunction is thus a collaborative effort between therapists and physicians, which should include a complete medical and psychosocial evaluation, as well as inclusion of the partner or spouse in the evaluation and treatment process.

Viagra and Beyond: Where Sex Educators and Therapists Fit in From a Multidisciplinary Perspective

New understanding of medical and surgical risk factors, new methods for scientific diagnosis, and new pharmacological options for treatment are all shaping the way we approach female sexual dysfunction. Sildenafil (Viagra) and similar drugs to treat sexual function complaints are here to stay, and will provide a range of phenomenal opportunities as well as potential pitfalls. One of the major roles of sex educators and therapists in the new millennium will be to help to monitor and adjust the global application of pharmacotherapy. The issue is not the availability of medication to treat sexual complaints, but how it is applied. Sex educators and therapists will be called upon to join teams of physicians and help make comprehensive diagnoses—not only for women, but for men as well. The time has come to join forces with the physicians and release the vacuum in which these fields have existed. It is not about whose approach is better; it is about determining the best approach for each individual patient and offering them the best, most effective, and thorough treatment options. By working together and sharing in this new era of opportunities, sex educators and therapists can continue to effectively attend to what we do best: helping others reach their full sexual potential.

Female Sexual Dysfunction: Epidemiology, Physiology, Evaluation, and Treatment

Female sexual dysfunction (FSD) is a multicausal and multidimensional problem affecting between 30–50% of American women (1,2). Based on the National Health and Social Life Survey of 1749 women, 43% have complaints of sexual dysfunction. Although this study has a large sample size and minority representation, it is limited by the cross-sectional design. In addition, women over age 60 were not included, and neither menopausal nor other medical risk factors were correlated with sexual complaints. Another study, which looked at 448 women over age 60, demonstrated that two-thirds of them were sexually inactive, 12% of married women had difficulty with intercourse, and approx 14% experienced pain with intercourse. Sexual activity was strongly correlated with marital status (3). Women over age 60 were less likely to have sex if their partner was of poor health and if they had low feelings of self-worth (4). Studies of older women have failed to include specific measures of female sexual arousal, orgasm, or satisfaction.