Female Sexual Dysfunction

Diagnosis

Psychological

The APA classifies sexual disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) because they tend to disrupt interpersonal relationships and cause psychological distress. All disorders listed in the DSM in some way disturb the process of arousal and the sexual response cycle. Although controversial, it is the standard approach used by many psychiatrists and clinicians in the United States and other countries to female sexual problems.

Hypoactive sexual desire disorder is characterized by an absence of libido. There is no interest in initiating sex and little desire to seek stimulation. Sexual aversion disorder is characterized by an aversion to or avoidance or dismissal of sexual prompts or sexual contact. It may be acquired following sexual or physical abuse or trauma and may be life-long. The main feature of female sexual arousal disorder is an inability to achieve and progress through the stages of "normal" female arousal. Female orgasmic disorder is defined as the delay or absence of orgasm after "normal" arousal. Dyspareunia is marked by genital pain before, during, or after intercourse. Vaginismus is the involuntary contraction of the perineal muscles around the vagina as a response to attempted penetration. Contraction makes vaginal penetration difficult or impossible.

These disorders must cause personal distress and must not be accounted for by a medical condition. A distinction is made between disorders that are life-long and those that are acquired, as well as those that are situational and generalized.

Medical

In cases where a medical condition is suspected as the underlying cause, whether it causes inadequate blood flow, nerve-related loss of sensitivity, or reduced hormone levels, a specialist conducts an appropriate diagnosis. Sexual problems may be symptomatic of diseases that require treatment, like diabetes, endocrine disorders of the hypothalamic-pituitary-gonadal axis, and neurological disorders.

The American Foundation of Urologic Disease (AFUD) classifies the APA's criteria into these four types of disorder:

• Hypoactive sexual desire disorder; includes sexual aversion disorder
• Sexual arousal disorder
• Orgasmic disorder
• Sexual pain disorders; includes vaginismus, dyspareunia

Contrary to APA stipulation, dyspareunia (pain during intercourse) may be diagnosed as a result of inadequate vaginal lubrication, which may be considered an arousal disorder and treated as such. Pain is associated with recurrent medical conditions, including cystitis.

Physiological Diagnostic Tests

Vaginal blood flow and engorgement (pooling and swelling of vaginal tissue) can be measured with vaginal photoplethysmography, in which an acrylic tampon-shaped instrument inserted in the vagina uses reflected light to sense flow and temperature. It cannot be used to assess advanced levels of arousal, say, during orgasm, because movement skews its reading. Also, limited knowledge of normative vaginal engorgement levels makes for only speculative results. Vaginal pH testing, commonly performed by gynecologists and urologists to detect bacteria-causing vaginitis, may be useful. A probe inserted into the vagina takes the reading. Decreasing hormone levels and diminished vaginal secretion associated with menopause cause a rise in pH (over 5), which is easily detected with the test. A biothesiometer, a small cylindrical instrument, may be used to assess the sensitivity of the clitoris and labia to pressure and temperature. Readings are taken before and after the subject watches erotic video and masturbates with a vibrator for approximately 15 minutes.

Treatmentt

There are three primary types of experimental treatment for female sexual dysfunction:

• Education on female anatomy, arousal, and response; where blood flow, hormone levels, and sexual anatomy are normal
• Hormone replacement therapy (including treatment of the underlying disorder)
• Vascular treatment (including treatment of the underlying disorder)

Educating both women and men on how to talk about and respond to a woman's psychological and physical stimulatory needs can only happen if both partners recognize that there is a problem. Behavioral and sex therapists note the need for partners to examine the actual act of having sex, including foreplay, intercourse, and talking about sex. Sex therapists and psychologists may assist in improving communication between partners.

Hormone replacement therapy (HRT) is aimed at restoring hormone levels affected by age, surgery, or hormone dysfunction to normal, thus restoring sexual function. Estrogen and testosterone levels are measured and treated by endocrinologists.

Sildenafil (Viagra®), used in men with erectile dysfunction, is currently being tested in women. Some evidence suggests that it may restore libido lost to antidepressant use.

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A medical condition that causes diminished blood flow to the vagina must be addressed in light of sexual dysfunction. However, some women who are not diagnosed with underlying medical conditions have found that nonprescription topical solutions, such as Sensua!™ (formerly called Viacreme®) or Viagel®, increase sensitivity and assist in achieving orgasm.

Sensua!™ is an amino-acid based (L-arginine) solution that contains menthol. L-Arginine is involved in nitric oxide synthesis, which is responsible for vascular and nonvascular smooth muscle relaxation. When applied to the clitoris, Sensua!™ may increase blood flow by dilating clitoral blood vessels. More research being done to assess the possible effects and complications of topical creams.

Eros Therapy™™

The Eros Therapy™ is an FDA-approved device for the treatment of female sexual dysfunction. This small handheld device is used 3 to 4 times per week to increase blood flow to the clitoris and external genitalia, which improves clitoral and genital sensitivity, lubrication, and the ability to experience orgasm. It may take several weeks of conditioning before experiencing the benefits of this therapy.

Next: Warning Signs Leading to Female Sexual Dysfunction