Sexual dysfunction is common A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution. While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor. What causes female sexual problems? Sexual dysfunction can be a result of a physical or psychological problem. • Physical causes. Many physical and/or medical conditions can cause sexual problems. These conditions include diabetes, heart disease, neurological diseases, hormonal imbalances, menopause, chronic diseases such as kidney disease or liver failure, alcoholism, and drug abuse. Moreover, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function. • Psychological causes. These include work-related stress and anxiety, concerns about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma. Who is affected by sexual problems? Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among those commonly affected are seniors, which may be related to a decline in health associated with aging. How do sexual problems affect women? The most common problems related to sexual dysfunction in women include: • Inhibited sexual desire • Inability to become aroused • Lack of orgasm (anorgasmia) • Painful intercourse We'll discuss each of these below. Inhibited sexual desire Inhibited sexual desire involves a lack of sexual desire or interest in sex. Many factors can contribute to a lack of desire, including hormonal changes, medical conditions and treatments (for example cancer and chemotherapy), depression, pregnancy, stress, and fatigue. Boredom with regular sexual routines also may contribute to a lack of enthusiasm for sex, as can lifestyle factors, such as careers and the care of children. Inability to become aroused For women, the inability to become physically aroused during sexual activity often involves insufficient vaginal lubrication. The inability to become aroused also may be related to anxiety or inadequate stimulation. Researchers are investigating how blood flow problems affecting the vagina and clitoris may contribute to female sexual arousal problems. Lack of Orgasm (Anorgasmia) Anorgasmia is the absence of sexual climax (orgasm). It can be caused by sexual inhibition, inexperience, lack of knowledge, and psychological factors such as guilt, anxiety, or a past sexual trauma or abuse. Other factors contributing to anorgasmia include insufficient stimulation, certain drugs, and chronic diseases. Painful intercourse Pain during intercourse can be caused by a number of problems, including endometriosis, a pelvic mass, ovarian cysts, vaginitis, poor lubrication, vaginal dryness, the presence of scar tissue from surgery, or a sexually transmitted disease. A condition called vaginismus is a painful, involuntary spasm of the muscles that surround the vaginal entrance. It may occur in women who fear that penetration will be painful, and also may stem from a sexual phobia or from a previous traumatic or painful experience. How is a female sexual problem diagnosed? To diagnose a woman's sexual problem, the doctor likely will begin with a physical exam and a thorough evaluation of symptoms. The doctor may perform a pelvic exam to evaluate the health of the reproductive organs and a Pap smear to detect changes in the cells of the cervix (to check for cancer or a pre-cancerous condition). The doctor may order other tests to rule out any medical problems that may be contributing to the problem. An evaluation of your attitude regarding sex, as well as other possible contributing factors (fear, anxiety, past sexual trauma/abuse, relationship problems, alcohol or drug abuse, for example) will help the doctor understand the underlying cause of the problem and make appropriate recommendations for treatment. How are female sexual problems treated? The ideal approach to treating sexual problems in women involves a team effort between the woman, doctors, and trained therapists. Most types of sexual problems can be corrected by treating the underlying physical or psychological problems. Other treatment strategies are shown on the next slides.