Opinion article
Female sexual dysfunction: arousal, orgasm and pain
Female sexual dysfunction is an umbrella term for persistent difficulties in one or more phases of the sexual response, arousal, orgasm, or pain-related, that cause significant distress. It’s common and remains underdiagnosed, partly because of embarrassment about raising it in a consultation.
Main types
- Arousal difficulty: lack of lubrication or physical response to sexual stimulation despite desire being present. It’s particularly common during perimenopause and menopause, due to falling oestrogen levels.
- Anorgasmia: marked difficulty or inability to reach orgasm despite stimulation that would be considered adequate.
- Pain related to sex: dyspareunia (pain during penetration) and vaginismus (involuntary contraction of the vaginal muscles that prevents or hinders penetration).
Causes
Causes are often multiple: hormonal (menopause, the postpartum period), medication-related (some antidepressants), pelvic floor dysfunction, and psychological or relational factors, including anxiety, stress or previous negative sexual experiences.
Treatment
- Treating the identified hormonal cause, when applicable.
- Vaginal lubricants and moisturisers for arousal difficulties.
- Pelvic floor physiotherapy, particularly effective for vaginismus and dyspareunia.
- Sex therapy or psychological support, alone or alongside physical treatment.
A multidisciplinary approach, involving gynaecology, pelvic floor physiotherapy and, when needed, psychology, tends to give better results than any single intervention on its own.
This article is for information only and does not replace a medical consultation.
Sources
- American College of Obstetricians and Gynecologists. Female Sexual Dysfunction: ACOG Practice Bulletin No. 213. Obstetrics & Gynecology. 2019.
- American College of Obstetricians and Gynecologists