Female Sexual Dysfunction: Causes and How It Is Assessed
Reduced desire, difficulty with arousal, orgasm problems and pain during intercourse: how are hormonal, physical and psychosocial causes distinguished? The assessment process and why the couple is considered together.
Sexual health problems are as common in women as in men, yet they are discussed far less often. A large proportion of women do not voice their complaint for years, and many do not even consider it a health matter. In fact these conditions can be defined, assessed and, to a large extent, addressed. This article is written to explain the subject in an informative and non-judgemental framework.
What does female sexual dysfunction mean?
The sexual response is a whole that spans desire, arousal, orgasm and comfortable intercourse. If there is a persistent problem at any of these stages that causes distress, we speak of sexual dysfunction. Two key words matter here: persistence, and the distress it causes. Occasional lack of desire or difficulty is an expected part of ordinary life.
Under which headings is it assessed?
- Reduced sexual desire: the most commonly voiced complaint, usually with multiple contributing factors.
- Difficulty with arousal: an insufficient physical response (lubrication, sense of fullness) even when desire is present.
- Difficulty with orgasm: inability to reach orgasm or a marked delay.
- Painful intercourse: pain at entry or deeper; involuntary contraction of the vaginal muscles is assessed separately under this heading.
Hormonal and physical causes
During menopause, changes in oestrogen levels can cause thinning of the tissues and dryness, leading to pain during intercourse and difficulty with arousal. The postpartum period, breastfeeding, thyroid disorders and diabetes can also affect the sexual response. Previous pelvic surgery, chronic pelvic pain, urinary incontinence and recurrent infections may accompany the picture. Assessment is therefore not limited to the sexual complaint; general health is considered as a whole.
The overlooked role of medication
Some drug groups can affect desire and orgasm. Antidepressants, certain blood pressure medicines and hormonal treatments should be reviewed from this perspective. What matters is that the person does not stop a medicine on her own, but shares the complaint with the prescribing doctor so that a change of dose or molecule can be discussed.
Psychosocial and relational factors
Stress, fatigue, disrupted sleep, body image, past negative experiences and communication problems within the relationship directly affect the sexual response. These factors are usually intertwined with physical causes: a woman who experiences pain because of menopausal dryness may over time develop avoidance and anxiety, so that the problem is no longer only hormonal. A good assessment therefore covers both sides.
How is the assessment carried out?
The process begins with a detailed, non-judgemental conversation: when the complaint began, whether it is constant or arises in particular circumstances, and — if there is pain — where and when it is felt. Where indicated, hormonal assessment and relevant examinations are planned, and current medications are reviewed. The aim is not to apply a label but to understand the picture correctly.
Why must the approach be multidisciplinary?
Female sexual health lies at the intersection of gynaecology, endocrinology, urology, pelvic floor physiotherapy and, where needed, sex therapy. Approaches reduced to a single heading usually fall short. Where pain is caused by excessive tension of the pelvic floor muscles, for example, physiotherapy is decisive, whereas in a menopause-related picture the priority is different. Planning is therefore carried out in cooperation with the relevant specialties.
Should the partner be assessed too?
Usually yes. Sexual life is a shared space; a problem in the partner (premature ejaculation or erectile dysfunction, for instance) may cause or sustain the woman's complaint. This is not about apportioning responsibility but about seeing the picture as a whole. Being able to discuss the subject within the couple in non-blaming terms is one of the most valuable steps in the process.
This page is for information purposes. Assessments relating to female sexual health are handled with full confidentiality and, where needed, planned in cooperation with the relevant specialties.