Sexual Dysfunction in Female

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Sexual Dysfunction in Female

The Sexual Dysfunction in Female:

Definition of Sexual Dysfunction in Female:

Sexual dysfunction is difficulty experienced by an individual or partners during any stage of a normal sexual activity, including physical pleasure, desire, preference, arousal or orgasm. The World Health Organization defines sexual dysfunction as a "person’s" inability to participate in a sexual relationship as they would wish". This definition is broad and gives way too many interpretations. Additionally, A diagnosis of sexual dysfunction under DSM-5 requires a person to feel extreme distress and interpersonal strain for a minimum of six months (except for substance- or medication-induced sexual dysfunction). Besides this, Sexual dysfunctions can have a profound impact on an individual’s perceived quality of sexual life.[1][3]

Overview

Overview of Sexual Dysfunction in Female

Female sexual dysfunction (in other words, FSD) has traditionally included disorders of desire, arousal, pain, and muted orgasm. The associated risk factors for FSD are similar to those in males i.e.: cardiovascular disease, endocrine disorders, hypertension, neurologic disorders, and smoking.

Epidemiologic data are limited, but the available estimates suggest that as many as 43% of women complain of at least one sexual problem. Despite the recent interest in organic causes of FSD, desire also arousal phase disorders remain the most common presenting problems when surveyed in a community-based population.

Causes

Causes of Sexual Dysfunction in Female

[1] Sexual Desire Disorder or Hypoactive sexual desire disorder

Decreased libido is characterized by a lack of or absence for some time of sexual desire or libido for sexual activity or of sexual fantasies.

Causes:

Decrease in the production of normal estrogen in women.
Ageing,
Fatigue,
Pregnancy,
Medications (such as the SSRIs) or psychiatric conditions, such as depression and anxiety.

[2] Sexual Arousal Disorder

Sexual arousal disorders were previously known as frigidity in women.
Frigidity has been replaced with a number of terms describing specific problems that can be broken down into four categories as described by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders: lack of desire, lack of arousal, pain during intercourse, and lack of orgasm.
For people of all genders, these conditions can manifest themselves as an aversion to and avoidance of sexual contact with a partner.
In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity.
There may be physiological origins to these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease can also contribute, as well as the nature of the relationship between the partners.

[3] Orgasm Disorder

Anorgasmia

It is classified as persistent delays or absence of orgasm following a normal sexual excitement phase in at least 75% of sexual encounters. The disorder can have physical, psychological, or pharmacological origins. SSRI antidepressants are a common pharmaceutical culprit, as they can delay orgasm or eliminate it entirely. A common physiological culprit of anorgasmia is menopause; one in three women report problems obtaining an orgasm during sexual stimulation following menopause.

Premature Ejaculation

It is when ejaculation occurs before the partner achieves orgasm, or a mutually satisfactory length of time has passed during intercourse. There is no correct length of time for intercourse to last, but generally, premature ejaculation is thought to occur when ejaculation occurs in under two minutes from the time of the insertion of the penis. For a diagnosis, the patient must have a chronic history of premature ejaculation, poor ejaculatory control, and the problem must cause feelings of dissatisfaction as well as distress the patient, the partner or both.

Historically attributed to psychological causes, new theories suggest that premature ejaculation may have an underlying neurobiological cause which may lead to rapid ejaculation.
Post-orgasmic Disorder

It symptoms shortly after orgasm or ejaculation. Post-coital tristesse (PCT) is a feeling of melancholy and anxiety after sexual intercourse that lasts for up to two hours.

POIS may involve adrenergic symptoms: rapid breathing, paranesthesia, palpitations, headaches, aphasia, nausea, itchy eyes, fever, muscle pain and weakness and fatigue.
The etiology of this condition is unknown; but it may present as anxiety relating to coital activities and thus may be incorrectly diagnosed as such. There is no known cure or treatment.

[4] Sexual pain Disorder

Sexual pain disorders in women include dyspareunia and vaginismus .

Causes:

Insufficient lubrication in women. Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause, pregnancy, or breastfeeding.
Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex.
It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma may play a role.
Another female sexual pain disorder is called vulvodynia or vulvar vestibuli is. In this condition, women experience burning pain during sex which seems to be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown.

Risk factor

Risk factor of Sexual Dysfunction in Female

Neurologic disease: stroke, spinal cord injury, parkinsonism Trauma, genital surgery, radiation
Endocrinopathies: diabetes, hyperprolactinemia Liver and/or renal failure
Cardiovascular disease
Psychological factors and interpersonal relationship disorders: sexual abuse, life stressors
Medications: Antiandrogens, Antidepressants, Antioestrogens or GnRH antagonists,Antihistamines,Antihypertensives,diuretics, Alkylating agents, Anticholinergics

Physiology

Physiology of the Female Sexual Response

The female sexual response requires the presence of estrogens. A role for androgens is also likely but less well established. In the CNS, estrogens and androgens work synergistically to enhance sexual arousal and response.

A number of studies reports enhanced libido in women during preovulatory phases of the menstrual cycle, suggesting that hormones involved in the ovulatory surge (e.g., estrogens) increase desire. Sexual motivation is heavily influenced by context, including the environment and partner factors.

Once sufficient sexual desire is reached, sexual arousal is mediated by the central and autonomic nervous systems. Cerebral sympathetic outflow is thought to increase desire, and peripheral parasympathetic activity results in clitoral Vaso congestion and vaginal secretion (lubrication).

The neurotransmitters for clitoral corporal engorgement are similar to those in the male, with a prominent role for neural, smooth-muscle, and endothelial released nitric oxide (NO).

Other Factors

A fine network of vaginal nerves and arterioles promotes a vaginal transudate. The major transmitters of this complex vaginal response are not certain, but roles for NO and Vaso intestinal polypeptide (VIP) are suspected.

Investigators studying the normal female sexual response have challenged the long-held construct of a linear and unmitigated relationship between initial desire, arousal, Vaso congestion, lubrication, and eventual orgasm.

Caregivers should consider a paradigm of a positive emotional and physical outcome with one, many, or no orgasmic peak and release.

Although there are anatomic differences as well as variation in the density of vascular and neural beds in males and females, the primary effectors of sexual response are strikingly similar. Intact sensation is important for arousal.

Thus, reduced levels of sexual functioning are more common in women with peripheral neuropathies (e.g., diabetes). Vaginal Lubrication is a transudate of serum that results from the increased pelvic blood flow associated with arousal.

Vascular insufficiency from a variety of causes may compromise adequate lubrication and result in dyspareunia. Cavernosal and arteriole smooth-muscle relaxation occurs via increased nitric oxide synthase (NOS) activity and produces engorgement in the clitoris and the surrounding vestibule.

Orgasm requires an intact sympathetic outflow tract; hence, orgasmic disorders are common in female patients with spinal cord injuries.

Types

Classification of Sexual Dysfunction in Female

It may Classified in to 4 categories i.e.

[1] Firstly, Hypoactive sexual desire disorder

[2] Secondly, Sexual Arousal Disorder

[3] Thirdly, Orgasm Disorder

[4] Fourthly, Sexual pain Disorder

Investigation

Investigation of Sexual Dysfunction in Female

Serum Prolactin
Serum Oestrogen
Gonadotropins
CBC
Blood sugar level
Lipid Profile
Thyroid profile

Diagnosis

Diagnosis of Sexual Dysfunction in Female

History medical, surgical, obstetric, psychological, gynecologic, sexual, and social information. Past experiences, intimacy, knowledge, and partner availability should also be ascertained.
Medical disorders that may affect sexual health should be delineated. They include diabetes, cardiovascular disease, gynecologic conditions, obstetric history, depression, anxiety disorders, and neurologic disease.
Medications should be reviewed as they may affect arousal, libido, and orgasm.
The need for counselling and recognizing life stresses should be identified.
The physical examination should Assess the genitalia, including the clitoris, Pelvic floor examination may identify prolapse or other disorders.
Laboratory studies are needed, especially if menopausal status is uncertain. Estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) are usually obtained, and dehydroepiandrosterone (DHEA) should be considered as it reflects adrenal androgen secretion.
Liver function assessment, and Lipid studies may be useful, if not otherwise obtained. Complicated diagnostic Evaluations such as clitoral Doppler Ultrasonography and biothesiometry require expensive equipment and are of uncertain utility. It is Important for the patient to identify which symptoms Are most distressing.
The Evaluation of FSD previously occurred mainly in a psychosocial context. However, inconsistencies between diagnostic categories based only on psychosocial Considerations and the emerging Recognition of organic.

Treatment

Treatment of Sexual Dysfunction in Female

GENERAL

An open discussion with the patient is important as couples may need to educate about normal anatomy and physiologic responses, including the role of orgasm, in sexual encounters.
Physiologic changes associated with aging and/or disease should explain. Couples may need to remind that clitoral stimulation rather than coital intromission may more beneficial. Behavioral modification and nonpharmacologic therapies should be a first step.
Patient and partner counselling may improve communication and relationship strains. Lifestyle changes involving known risk factors can an important part of the treatment process.
Emphasis on maximizing physical health and avoiding lifestyles (e.g., smoking, alcohol abuse) and medications likely to produce FSD is important.
The use of topical lubricants may address complaints of dyspareunia and dryness. Contributing medications such as antidepressants may need to be altered, including the use of medications with less impact on sexual function, dose reduction, medication switching, or drug holidays.

HORMONAL THERAPY

In postmenopausal women, estrogen replacement therapy may be helpful in treating vaginal atrophy, decreasing coital pain, and improving clitoral sensitivity.
Estrogen replacement in the form of local cream is the preferred method, as it avoids systemic side effects.
Androgen levels in women decline substantially before menopause.
However, low levels of testosterone or DHEA are not effective predictors of a positive therapeutic outcome with androgen therapy.
The widespread use of exogenous androgens is not supported by the literature except in select circumstances and in secondary arousal disorders.

ORAL AGENTS

The efficacy of PDE-5i in FSD has been a marked disappointment in light of the proposed role of nitric oxide–dependent physiology in the normal female sexual response.
The use of PDE-5i for FSD should be discouraged pending proof that it is effective.

CLITORAL VACUUM DEVICE

In patients with arousal and orgasmic difficulties, the option of using a clitoral vacuum device may be explored.
This handheld battery-operated device has a small soft plastic cup that applies a vacuum over the stimulated clitoris.
This causes increased cavernosal blood flow, engorgement, and vaginal lubrication.

Homeopathic Treatment

Homeopathic Treatment of Sexual Dysfunction in Female

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

The medical history of the patient,
Physical and mental constitution,
Family history,
Presenting symptoms,
Underlying pathology,
Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Sexual Dysfunction in Female:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:

SEPIA:

It is a good remedy for FSD.
Sepia woman is highly irritable, sensitive, and angry, easily offended and miserable due to weak uterine problems.
Low sex drive is due to the relaxation of pelvic muscles, and there is a bearing down sensation as if everything would escape through the vagina.
Aversion to coition due to prolapsed of uterus and vagina wall.
Frigidity from childbirth after weaning or hormone pills.
Nausea and irritability on thought of sex.
Great weakness after sex. Aversion to whom she loved best and other family members.

AGNUS CASTUS:

Sexual desire almost absent.
Sexual thrill absent due to excessive masturbation.
Aversion to sex.
Relaxation of genitals with leucorrhoea.
Great sadness, depression and sexual melancholy.
Diminished sexual desire with complete prostration and general debility.

BERBERIS VULGARIS:

Berberis vulgaris is suitable to listless, apathetic also indifferent woman.
Sexual desire absent due to pain during coition.
Cutting, stitching pains during coition. In detail, Vaginismus.
Vagina very sensitive, pinching constriction in mons veneris, contraction also tenderness of vagina.
Burning and soreness in vagina after intercourse.
Enjoyment absents during sex. Besides this, Great prostration after sex.
Neuralgia of ovaries and vagina are other factors for low sex drive.

ONOSMODIUM:

Onosmodium is another effective medicine for low sex drive in woman.
Sexual desire completely absent due to uterine pain and bearing down pains.
Soreness of ovaries with rectum.
The woman has low power of concentration and co-ordination.
She has early and prolonged menses, Great prostration, weak, timid. Often suffers from migraine headache.
Sexual neurasthenia, weariness, tiredness in legs.

STAPHYSAGRIA:

Aversion to sex due to past history of rape or sexual abuse.
Vaginismus, vagina is very sensitive to touch.
Ovarian pain, going into thighs, worse pressure or sex.
Prolapse with sinking feeling in the abdomen.
Staphysagria patient often prefers solitude.
Frequent urinary infection, which is worse from intercourse.

IGNATIA MARA :

Best indicated medicine in FSD.
Sexual desire absent, especially in vehement woman.
They are moody, emotional, sensitive and easily excited.
Aversion to sex due to vaginismus, vagina very sensitive.
Intense pain at the entrance of vagina during coition with burning heat.
Sexual desire absents after grief, shock, disappointment, frustration, and worry. Patient is worse after coition.

HELONIU

Tendency to inflammation of vulva also vagina, with formation of pus.
Persistent itching of genitals either with or without formation of blisters or sores.
Foul smelling leucorrhea.