Sexual Problems in Women

Hypoactive Sexual Desire Disorder

This is the most common female sexual disorder. It occurs when there is an absence of sexual fantasies or desire for sexual activity. It causes marked distress or interpersonal difficulty, cannot be accounted for by another diagnosis. Once diagnosed, this condition is very amenable to treatment with hormone supplements, especially in women with a documented low level of hormones, or with appropriate sexual therapy. Sexual therapy plays a very important role in this type of disorder.

Sexual Aversion Disorder

Sexual Aversion Disorder is the avoidance of genital sexual contact with a sexual partner. It causes marked distress or interpersonal difficulties and that the affected individual reports anxiety, fear or disgust when confronted by a sexual opportunity with a partner. This aversion to genital contact may be focused on a particular aspect of the sexual experience including genital secretions or vaginal penetration. Rarely, some individuals may feel revolted by all sexual stimuli, including kissing and touching and may experience a severe panic attack when sexual intercourse is initiated. The disorder may be associated with other sexual dysfunctions including painful penetration. These individuals will go to heroic lengths to avoid participating in sexual activity.

This condition generally affects women who have been through some type of sexual crisis such as rape, gang rape, forced sex, or sex with a family member. This disorder is also very common in religious orders as some faiths have very strict rules about sexual activity.

Female Sexual Arousal Disorder

The second most common type of female sexual dysfunction, female sexual arousal disorder, is characterised by a persistent or recurrent inability to obtain or maintain adequate lubrication or swelling response during the excitement phase. As with other diagnoses, this disturbance must cause marked interpersonal difficulties or distress and should not be accounted for by another disorder or by medications. This is the most common sexual disorder seen in postmenopausal women due to a lack of adequate lubrication. Prior to the advent of new medications, this was treated with vaginal lubricants such as K-Y jelly or others that are commercially available. The most common lubricant used, saliva, is probably the most physiologically compatible and the most reasonable. Other lubricants, including K-Y jelly and petroleum-based products like Vaseline, do not correct the uncomfortable feeling but only provide more lubrication.

When this condition is seen in young women, it is almost always related to the side effects from such medications as birth control pills. Diabetes, especially a long-standing case, may cause a decrease in lubrication and may also cause decreased blood flow, which results in a higher risk of developing bacterial and fungal infections in the vagina.

Female Orgasmic Disorders

Female Orgasmic Disorder is described as a persistent or recurrent delay or absence of an orgasm following the normal sexual excitement phase. This is an extremely difficult diagnosis to make and, unfortunately, may be much more common than we imagine. This disorder is more difficult to characterise because of the difficulty in documenting the female orgasm.

Female Orgasmic Disorders 
Dyspareunia is genital pain associated with sexual intercourse. The condition is found in both men and women, but it is far more common in women and is considered a female condition. When one discusses pain during vaginal penetration, it is important to characterise exactly where the pain occurs. Pain can be associated with initial penetration or during deep thrusting. The intensity of the pain may be such that intercourse is impossible. Again, before it can be considered a diagnosis, this disturbance must cause marked distress or interpersonal difficulties. The pain should not be that associated with vaginismus or lack of lubrication (both discussed elsewhere), as both of these disorders fall into other classes of disorder.

General medication conditions that cause painful penetration would include such sexually transmitted diseases as vaginal herpes or bacterial infections. Yeast infections would also fall into this category and are very common in women.

Posterior fourchette

While this is fairly unusual, this condition can be associated with severe pain during penetration. The diagnosis of dyspareunia is almost always associated with an organic condition and only a careful history and physical examination will discern the exact cause and allow the exact treatment to be recommended.

Vaginismus

Vaginismus is defined as the recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when insertion of any object is attempted, such as a penis, finger or even a tampon. Again, before making this diagnosis, a doctor should ascertain that the disturbance causes marked distress or interpersonal difficulty. Generally, this is the case when a patient comes for help with vaginismus because she's generally exhausted all obvious options. Vaginismus may be readily apparent on an attempted vaginal examination. It is important to differentiate vaginismus from dyspareunia because the diagnosis is almost always associated with psychiatric problems or a prior history of sexual abuse or sexual trauma. This disorder is almost always found in younger rather than older women and in women with negative attitudes towards sexual intercourse, a history of prior rape, sexual trauma, or even incest. Vaginismus is the rarest of the female sexual dysfunction disorders and is almost always associated with other diagnoses. Vaginismus can affect the perineal muscles as well as the levator muscles, which are the muscles that help hold up the rectum.

It is important to be sure of a vaginismus diagnosis because of its tremendous psychiatric overtones. It's extremely important that this diagnosis is not made on the basis of history alone but also should be based on physical examination. The classic theory of vaginismus is that a woman will experience severe pain with attempts at the penetration of her vagina with either her finger or a tampon and this causes a natural, self-protective, tightening response that prevents penetration at a later time. Unfortunately, this condition causes avoidance behaviour that can lead to substantial marital discord.