Sexual health

Female sexual dysfunction

Female sexual dysfunction is defined as any physical or psychological issues that can interfere with a woman’s ability to enjoy sex. Female sexual dysfunction include poor libido or sexual interest, difficulty achieving orgasm during intercourse and pain during sexual penetration. Low sexual desire and rarely reaching orgasm were the most commonly reported types of female sexual dysunction and there is considerable interdependence that exist between the different sexual dysfunction, which means that a woman can experience one or more sexual dysfunction at one time. 

Normal sexual function is a complex factor that interplay between the mind and body. The physical aspects of female sexual function are coordinated by neurologic, vascular and endocrine systems. It is a common problem affecting between 20–50% of women and can be physically and emotionally distressing as well as socially disruptive to one’s relationship.

Ageing cause dramatic fluctuations in level of sex hormones  especially the time before the menopause ('perimenopausal') and during menopause leading to decreased libido, vaginal dryness and painful intercourse. Hot flushes can also interrupt the sleep pattern leading to fatigue and poor physical performance. Other hormonal changes such as pregnancy, childbirth, breastfeeding, use of medication that can alter hormone level such as oral contraceptive pills and hormone replacement therapy (HRT) can also affect female sexual function.

There are various medical and surgical conditions that can affect female sexual behaviour such as organ failures (heart disease, kidney and liver failure), hormonal imbalance (diabetes, thyroid disease and hyperprolactinemia), neurologic disorders (stroke and multiple sclerosis), previous pelvic surgery (caesarean section and hysterectomy) and radiation the the pelvic area from cancer treatment.

There are also various medications that can affect female sexual function such as anti-anxiety medications, anti-epileptic medications, anti-depressant, cancer treatment such as chemotherapy, heart and blood pressure medications, opioid- type analgesia and steroid. 

There are certain gynaecological disorder and sexually transmitted diseases (STD) that can interfere with female sexual function such as endometriosis, adenomyosis, large pelvic mass such as fibroid, ovarian cyst or pelvic mass, vaginismus and dyspareunia caused by pelvic inflammatory diseases (PID) secondary to sexually transmitted infection such as Chlamydia and Gonorrhoea.

Other factors such psychological issues such as excessive stress, over-work, depression, anxiety, past physical and sexual abuse and post- traumatic disorder (PTSD), unhealthy lifestyle practices such as smoking, excessive alcohol intake, lack of exercises, unhealthy diet and excessive weight, as well as relationship issues such as conflicts, family commitment, financial issues, communication issue, and lack of attraction to the partner can also negatively influence female sexual function.

Treatment of female sexual dysfunction require comprehensive history, physical assessment and several investigation to exclude medical and gynaecological disorders. Treatment of underlying female sexual dysfunction is based on the underlying cause. Several medical treatments are used to treat female sexual dysfunctions such as muscle relaxant, local anaesthetic cream, topical estrogen cream, Tibolone and testosterone drug replacement (albeit controversial). Non-pharmacological therapy includes use of dilators, Kegel’s exercise, couple or sex therapy, arousal techniques such as use of vibrator and vaginal lubricants and moisturizer.

Female sexual dysfunction can cause serious implications to your relationship and can cause difficulty to achieve successful pregnancy. Occasional sexual problems are a normal part of life, however, if it’s persistent and recurring, have an open communication with your partner and get medical professional advice for an assessment.