Persistent or recurrent problems with sexual response or sexual desire that distresses sexually active women or causes strain in the relationship with her partner is known medically as Female Sexual Dysfunction (FSD).

At some point in their lives many women experience problems with sexual intercourse. FSD can occur at all stages of life.

FSD can manifest as,

1. Low sexual desire – This could manifest as lack of libido or loss of sexual drive
2. Sexual Arousal Disorder- Here woman’s desire for sex is intact but the person has a difficulty to become aroused or has problems to maintain the arousal during sexual intercourse
3. Orgasmic disorder- Here woman has persistent difficulty in achieving orgasm even after sufficient sexual arousal
4. Sexual pain disorder – In this, there is associated pain with sexual stimulation or vaginal contact.

Sexual response is a combined interaction of emotions, experiences, beliefs, lifestyle and relationships. Disruption of any of theses components can affect sexual drive, sexual arousal and sexual satisfaction. But, in general FSD is treatable.
Sexual dysfunction problems are known to happen when there is a hormonal imbalance situation such as peri-menopausal (40+ years) to menopause transition (50+ years). FSD can also be seen in the immediate period after the baby is born. Sometimes this could be because of associated medical conditions such as Diabetes, blood pressure or heart problems or cancer.

Anxiety and depression can contribute to FSD. Longstanding conflicts with partner about sex or other aspects of relationship can diminish sexual responsiveness.
When a specialist input is needed?

If sexual problems are affecting the relationship or disrupting one’s peace of mind, then it is advisable to see a specialist.
Medical problems which may contribute to FSD;

Joint problems (arthritis), difficulties in water works or emptying bowel, pelvic surgery, and easy fatigability.

Certain medications can contribute to FSD and common ones are mood elevators, blood pressure medicines and chemotherapy medications. All these medications can decrease the sexual drive and cause problems with experiencing orgasm

Natural hormonal changes and FSD:

Decreased oestrogen levels after menopause may cause changes in genitalia and sexual responsiveness. The vaginal lips (labia majora) can become thin. This thinning causes more exposure of clitoris. This increased exposure of clitoris can reduce the sensitivity of clitoris.

Internally, the lining of vaginal skin becomes thinner and less stretchable causing a need for more stimulation to relax and lubricate before sexual intercourse. The above situation can cause painful sexual intercourse and this in turn may take longer time to experience orgasm.

Similarly after childbirth and during breast-feeding, there’s a shift in the body’s hormone levels and these can cause vaginal dryness and cause problems with desire for sex.
Preparing for a Consultation:
Minority of women may feel embarrassed to talk about sex with an health professional. But, from the health professional’s point of view, it is perfectly appropriate.

A satisfying sexual life is important to woman’s wellbeing at every age and stage of life.

One may have a treatable, underlying condition or may benefit from changes in lifestyle or sometimes combination of both.

The more forthcoming one is about their sexual history and current problems, higher the chances of finding an effective approach to treating them.

Treatment options

Women with sexual problems often benefit from two-pronged approach that addresses medical as well as relationship issues.

The non-medical strategies to treat FSD are,

• Open and honest communication with the partner can make a huge difference in sexual satisfaction. Learning to talk about likes and dislikes, learning to provide a feedback in a nice way can set the stage for greater intimacy
• One should not forget to practice healthy lifestyle habits. This could be by cutting down on alcohol, stopping smoking. Smoking causes reduction in blood flow to sexual organs and thus contributing for problems with sexual arousal

Sexual & relationship counseling sessions:

This often includes education about optimization of body’s sexual response, ways to enhance intimacy with partner. If there is vaginal dryness, then use of simple lubricant may help to alleviate the dryness or pain during intercourse.

Medical Treatment:

Effective treatment of FSD often involves ruling out any underlying medical condition or ruling out any hormonal imbalance situation. Things to rule out are, thyroid disorder, optimise treatment for depression or anxiety, or strategies to relieve pelvic pain.

FSD linking to hormonal cause can be managed by,

• Oestrogens – Topical oestrogen in the form of pessary or cream or ring may benefit sexual function by improving vaginal tone and elasticity. This is by increasing vaginal blood flow and enhancing lubrication.

• Androgen therapy – These include male hormones. Testosterone plays a role in healthy sexual function in both women and men. The risks of hormone therapy may very depending on whether oestrogen is given alone or with progestin.

• Tibolone – It’s a synthetic steroid used for treatment of postmenopausal osteoporosis. Scientific studies have also shown beneficial effects of improvement in overall sexual function and reduction in personal distress compared with postmenopausal women taking oestrogens. But one should be cautious, as there are concerns of increased risk of breast cancer and stroke.

• Sildenafil (Viagra) – It does not work as well in females with FSD as in men. Studies have shown inconsistent results. One group of women who are on SSRI group of antidepressants may benefit from short course of Sildenafil

Home remedies:

• Being physically active, regular aerobic exercise increases stamina, improves body image and elevates mood. This can help feel more romantic.

• Give time for relaxation – learn ways to decrease stress and find ways to relax. Being relaxed can enhance one’s ability to focus on sexual experiences and may help attain more arousal and orgasm.

Other interventions:
• Mindfulness meditation: Studies have shown that, mindfulness meditation practiced during group therapy improved many aspects of sexual response and women saw improvement in desire and arousal.
• Yoga: In this, a series of postures and controlled breathing exercises  are performed to promote a more flexible body and a calm mind. Certain subsets of yoga are aim to channel the body’s sexual energy and improve sexual functioning. Practice of Yoga is associated with improved psychological well being and overall health.

Coping and support

• One should understand their body and what makes a healthy sexual response
• Communicate openly with partner
• Explore and understand aspects of sexuality during times of transition such as peri-menopause to menopause or short-term issues such as breast-feeding related.
• Sexual response often has much to do with one’s feelings for their partner and one should attempt to reconnect and discover each other.

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