Female Sexual Dysfunction. The media tends to present sex as easy, good and spontaneous and it implies that we should always be in the mood for it. If only sex were that simple. The issues of intimacy are of great interest and concern to both men and women. Many knowledgeable doctors now recognize the interrelationship between sex, sexuality and level of health, vitality and function of their patients’ lives. Many doctors now realize that sexual satisfaction is an indicator of overall health and are now including the area of sexuality in their medical histories. Knowledgeable doctors now evaluate patients with a view to not only helping them with their presenting complaints, but also look for opportunities to enhance and improve their sex life at the same time. Many patients, both male and female, are however uncomfortable going into details about this very personal area of their lives. They may often just answer “fine”, “ok”, and “no problem” when answering the sexual part of the medical questionnaire even when all is not well with their sex life. The overall attitude of secrecy, shame and uncertainty about the role of sexuality in overall health can be well summarized by a recent letter received by a physician.

“I am 52 years of age and so is my husband, it is about our sex life, it just seems like its gone. Is that normal for our age or can we be low on certain vitamins? Is there something we can get to boost our sex drive? We always had a good sex life and now it is totally gone.”

Participating in sexual activities is a good indicator of overall vitality. Loss of interest in sex is a very negative sign for a person’s good health and longevity. Blockages in sexual energy will often manifest as deterioration in general health or mental state. As reflected in the email, there is a general myth that sexual energy wanes and disappears with age. The emailer and her husband are only 52 years old, yet she wonders whether a sex life that is “just gone” might be normal for that age. Well it’s not normal for that age, or any other age. Continuing to have good health involves continuing to have a sex drive. Many things can sabotage a normal and enjoyable sex life. If you and your partner are experiencing problems with sex, you are not alone. Recent studies reveal that nearly 40 to 90 percent of women of all ages report having sexual problems.

Many women experience sexual difficulties at some point in their lives. During menopause, as many as half of all women or even more, may experience sexual dysfunction. Sexual function is no exception. At age 60 for example, one’s sexual needs, patterns and performance may not be the same as they were when one was half that age.

What Are Female Sexual Problems?
There are a variety of sexual problems that women experience, either alone or with a partner. The term “sex” is not limited to just intercourse, and can also refer to a variety of intimate sexual activities such as fondling, self stimulation or masturbation and oral sex. Sexual problems are generally defined as any problem that occurs in the course of sexual activity, including: not being in the mood, trouble becoming aroused, which usually involves being too dry, difficulty having orgasms, pain during sex or pain related to sexual activity.

Most women experience these from time to time. It is when they are persistent that they become problematic for the woman and her partner.  You should seek help more promptly if you are experiencing physical pain.

Defining the Problems.
Sexual dysfunction is simply persistent or recurrent problems during one or more of the stages of having sex. It is not considered a sexual disorder unless you are distressed about it or it negatively affects your relationship with your partner. Female Sexual Dysfunction (FSD) occurs in women of all ages.

Doctors and sex therapists generally divide sexual dysfunction in women into four categories. These are:
Low Sexual Desire.
In this case you have poor libido, or lack of sex drive.  This is the most common type of sexual disorder among women and accounts for 87.2% of the cases of FSD. It is the persistent or recurrent lack of sexual thoughts and/or receptivity to sexual activity, which causes personal distress. Low sexual desire may result from endocrine failure and may be associated with psychological or emotional disorders. Sexual aversion disorder is a subcategory of low sexual desire.

Sexual Arousal Disorder
In this situation your desire for sex might be intact, but you’re unable to become aroused or maintain arousal during sexual activity. It is persistent or recurrent inability to reach or maintain sexual excitement, which causes personal distress. This disorder includes poor vaginal lubrication, decreased genital sensation and poor vaginal muscle relaxation. Arousal disorders are most commonly physiological and can often result from medications, pelvic disorders, as well as neural and peripheral vascular diseases and accounts for 74.7% of FSD.

FSD with orgasmic disorder, which accounts for 83.3%% of cases of FSD, you have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation. It is the persistent or recurrent failure to reach orgasm after sufficient sexual  stimulation and arousal which causes personal distress trauma to nerves associated with pelvic surgery and spinal cord injury can be associated with orgasmic failure.

There is sexual pain disorder in which the vagina is painful after being sexually stimulated or touched. Subcategories include painful intercourse and vagina spasm. This may be caused by injuries during operations and physical or psychological trauma involving the pelvis. This accounts for 71.7% of FSD. It is important to recognize that FSD is far more common in patients with a history of sexual abuse or rape. 40% of women who reported that they have been sexually abused had problems with FSD.

Not all sexual problems in women fit into these categories. With increased information about the complicated nature of female sexual response, a new view has emerged which focuses on the concept that female sexual response is a combination of complex interactions of many components, including the woman’s physiology, emotions, experiences, beliefs, lifestyle and relationships and that all these factors must be favourable for a woman to create an emotional intimacy with her partner so that she can respond to sexual stimuli, which then can lead to arousal. However, an unsatisfactory sex life must be distressful to quality as FSD.

What Causes Female Sexual Problems?
Sexual problems can be influenced by a wide varieties of factors such as physical, drugs, hormonal, psychology and social factors. Physical conditions that may cause or contribute to sexual problems include arthritis, urinary or bowel difficulties, pelvic surgery and trauma, fatigue, headaches, neurological disorders, diabetes and untreated pain syndromes.

Certain medications, including some antidepressants, blood pressure medications, antihistamines and drugs for cancer treatment, can decrease sexual desire and one’s ability to achieve orgasm. There are certain times in a woman’s life when she is more likely to have sexual problems because of hormonal changes. For example, some women experience a range of sexual responses right after childbirth and during menopause. Menopause can affect women’s sexual functioning during midlife. Estrogen deficiency after menopause may lead to changes in a woman’s genitals and in her sexual response. The folds of skin that cover the genital region or labia shrink and become thinner, exposing more of the clitoris. This increased exposure sometimes reduces the sensitivity of the clitoris or may cause an unpleasant tingling or pricking sensation. In addition, with the thinning and decreased elasticity of its lining, the vagina becomes narrower, particularly if sexually active. Also, the natural swelling and lubrication of the vagina occurs more slowly during arousal. These factors can lead to difficult or painful intercourse called dyspareunia, and achieving orgasm may take longer.

Psychological factors that cause or contribute to sexual problems include emotional difficulties such as untreated anxiety, depression or stress and a history of sexual abuse. A woman may find it difficult to fill multiple needs and roles, such as job demands, home making, being a mother and caring for aged parents. One’s partner’s age and health, one’s feeling toward one’s partner and a woman’s view of her own body or that of her partner are additional factors that may combine to cause sexual problems. Cultural and religious issues also may be contributing factors.

From birth throughout her life, every woman is developing a unique “sexual story” influenced by culture, gender, family of origin, and personal experiences. The “story” takes on the beliefs and meanings that she attributes to her sexuality. Couples must negotiate their personal “sexual stories” as they develop their own style of sexual communication and activity. This should be an ongoing process, since everyday life problems may get in the way of intimacy and sexuality. Job worries, pressures of juggling work and family, substance abuse, depression and financial worries can all influence how you feel sexually. In our fast paced world, having a lot on your mind, as most people do, can get in the way even when you want to focus on being intimate.

Over time, psychological troubles can create biological problems and vice versa. It all starts to blur together so you can’t really pinpoint where the issues started. You just know you want help.

How Do You Know When To Seek Help?
It really depends on the woman and her partner. Sometimes a problem seems to go away pretty quickly on its own but if this is something that is really worrying or frustrating you or your partner and does not seem to go away no matter what you try, or if you are experiencing considerable pain or discomfort, it may be time to consider professional help.

How Do You Get Help?
The problem of FSD is real for millions of women. Its rarely a simple issue, because sexual pleasure and sexual distress involves a complex web of physical and emotional factors.

First of all, have an honest discussion with your partner. Sexual pleasure is the result of mind/body cooperation between two people. Surveys confirm that the most satisfying sexual activity is the product of a caring secure personal relationship. When one partner is dysfunctional, the other is affected as well. For example, a woman may interpret her partner’s inability to have an erection as a sign that he no longer finds her attractive. This may not be so. He may just be having some emotional issues in other areas of his life such as work or finances that are not related to how he feels about his wife. A talk with one’s partner can help to determine whether the problem is  primarily physical or emotional.

A good first step if you are experiencing problems is to recognize the problem and to seek the help of a doctor.

Although sexual problems involve many issues, they’re often treatable. Communicating your concerns and understanding your anatomy and your body’s normal physiologic response to sexual stimulation are important steps towards regaining your sexual health.

Help is available through both individual or couples therapy. Many people will use a combination of the two. When a couple begins therapy, the therapist may refer one or both partners to a physician to rule out any medical conditions that could be contributing to the problem. The therapist or physician should fully inform you of the reasons for the medical procedure. A physician can also help with the issues surrounding medication, like experimenting with the dosage of your medication to reduce sexual side effects. There are some hormonal treatments for women that are helpful during and after menopause.

Therapy can help women, either alone or with a partner who are experiencing sexual problems. Most therapists are used to talking to couples about their sexual lives and will not be embarrassed if you bring it up.  The therapist is there to help the woman and her partner gain understanding of some of the relationship dynamics and background issues that may be influencing the problem. The therapist can also provide you with information about human sexuality and sexual functioning, and answer your questions.

Clinical Evaluation
Few women volunteer a history of FSD and therefore the doctor as part of the routine medical history should actively seek information. The initial question a clinician could ask is, “How is your intimate life?”. Questions regarding interest, arousal, orgasm and pain can also be asked. The evaluation should include the specifics of the patient’s FSD, review of over the counter prescription and street drugs, and tobacco use. Physical evaluation should include a pelvic examination to search for evidence of vaginal atrophy, dryness and pain triggering spots. The clinician should refer to other health professionals if she/he does not have the time needed to perform a thorough evaluation and discuss appropriate treatments. A sexual therapist should be consulted early because the patient’s symptoms may have many factors and because the patient’s symptoms may have many factors and because sexual education and psychological evaluations are the important parts of every evaluation and treatment plan.

The clinical assessment of FSD may include the use of questionnaires to monitor the success of the treatment. An endocrine evaluation may be needed for some patients. Many hormones control both the male and female sex drive. An imbalance of these hormones will affect a person’s sexuality. Such an evaluation may include measurement of the following hormones such as the serum follicle-stimulating hormone or FSH, luteinizing hormone or LH, serum estradiol, dehydroepiandrosterone or DHEA, total testosterone, free testosterone and prolactin levels. After the deficient hormones been supplemented, the doctor will then test the vagina PH, genital blood flow, vagina wall compliance, vaginal engorgement with use of pre-stimulation and post-stimulation, and genital vibratory sensation thresholds to see whether the hormone treatment is working.

Research on FSD is becoming popular. The basic physiologic processes in normal female sexual function are being defined. It is known that sexual response in women depends on the woman’s  body, her nerves and her mind. Infact, sensation is important in arousal and therefore, poorer levels of sexual functioning may be expected in diabetic women with nerve damage to the limbs. Vaginal lubrication to enable arousal is dependent on a good flow of blood from the pelvis. Therefore, if blood vessels are damaged, it reduces lubrication and leads to painful intercourse and orgasm. Therefore orgasmic disorders are common in female patients with spinal cord injuries.

Treating the Problem
Educating the patient and her partner about the normal functioning of her body is often necessary. Additionally, physiologic changes associated with aging and/or disability and blood vessels dysfunction should be explained. The clear correlation between the patient’s general health and sexual function must be emphasized. Thus, maximizing physical health and avoiding medications likely to produce FSD are the first steps in restoring normal sexual function.FEMALE SEXUAL DYSFUNCTION

The patient should be encouraged to stop smoking and consuming alcohol to maintain or regain sexual function. For physical condition, the doctor must also treat the underlying cause of the dysfunction. For example, patients with renal failure may be given renal transplantation. Because FSD is commonly caused by antidepressants, patients with FSD may respond to a reduction in dose of the antidepressant drug or the doctor may switch to another antidepressant that the sufferer responds better to. Drugs like viagra have been known to help in some cases of FSD.

Physical changes brought on by menopause, such as vaginal dryness and thinning might require the use of hormonal therapy or vaginal lubricants. To help strengthen the vagina muscle or to increase sexual stimulation, the doctor may recommend a set of simple exercise such as Kegel exercises, masturbation, use of a vibrator.

Over the years in Europe a brilliant Austrian physician,. Dr. Mayr developed the Mayr therapy as a means of getting to a healthy state. This and the use of some orthomolecular supplements such  as Biofemme and Biosis creams,  during and after the therapy have been found to be very helpful in overcoming many of the menopausal symptoms and thereby increasing sexual desire and equally having sexual satisfaction. Luckily there is the Martlife detox clinic a health farm in Lagos that is able to provide Mayr therapy.