Female Sexual Dysfunction

Female sexual dysfunction is diagnosed and treated by the Urology Division as well as the Women’s Center for Continence and Sexual Health.

What is female sexual dysfunction?

Female sexual dysfunction (FSD) occurs when a woman doesn’t get excited, or when she is sexually excited, doesn’t become physically aroused, or lubricated. If you suffer from problems with sex, you are not alone. Four in ten women experience sexuality problems, but very few actually seek help.

From an early age, women are overwhelmed with media messages about what their bodies should look like and how they should act sexually. Other influences are from family, culture, and even religion. Female sexual dysfunction may be the result of a complex blend of emotional and physical stimuli.

Research into the area of female sexual dysfunction has received more attention in recent years, and physicians and therapist are learning more and more about how this affects women.

Dr. Evan Goldfischer is director of the Premier Medical Group Urology Division research department, and served as Principal Investigator for several drugs being studied to treat FSD.

What causes female sexual dysfunction?

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There is new and important information about female sexual response that we are only beginning to appreciate. Studies continue to provide an understanding of the blood vessels and nerves in the pelvis, and the ways in which surgeries, childbirth, illnesses, medications, hormonal changes and aging may affect a woman’s sexual experience.

Research into this area has become more of a focus in recent years and we are learning more about it every day.

What are the symptoms of female sexual dysfunction?

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Female sexual dysfunction is associated with negative effects including poor self-image, mood instability, depression, and strained relationships with partners.

  • Decreased or no interest in sex–either the woman’s level of interest does not match up with her partner’s, or she has no interest in sex.
  • Difficulty having an orgasm–either the woman has never had an orgasm or she no longer has them.
  • Painful intercourse–difficult intercourse, or physically irritating.
  • Strained relationships–does not feel emotionally close to or trusting of her partner.

Dr. Evan Goldfischer sees patients in the Poughkeepsie office for FSD. He has lectured on the subject both nationally and internationally, in addition to publishing extensively on the topic.

How is female sexual dysfunction diagnosed?

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Your physician will begin with general questions about sexual activity then becoming more specific. Using a written scale or questionnaire, patients are asked to rate their sexual satisfaction on a scale of 1-10.

Sample questionnaire:

Question: Yes or No

  • In the past, was your level of sexual desire/interest good and satisfying to you?
  • Has there been a decrease in your level of sexual desire?
  • Are you bothered by your decreased level of sexual desire/interest?
  • Would you like your level of sexual desire/interest to increase?

Please check all the factors that you feel may be contributing to your current decrease in sexual interest.

  • An operation, depression, injuries, or other medical condition
  • Medications, drugs, or alcohol you are currently taking
  • Pregnancy, recent childbirth, menopausal symptoms
  • Other sexual issues you may have (pain, decreased arousal, orgasm)
  • Your partner’s sexual problems
  • Dissatisfaction with your relationship or partner
  • Stress fatigue

What are the types of female sexual dysfunction?

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There are several types of female sexual dysfunction, including hypoactive sexual desire disorder, sexual arousal disorder, orgasmic disorder, and sexual aversion disorder. All these disorders are classified as persistent or recurrent and cause marked distress or interpersonal difficulty. The sexual dysfunction is not better accounted for by any general medical or psychiatric condition and not due exclusively to the direct physiological effect of a substance or medication.

Female sexual dysfunction is classified as the following:

Hypoactive Sexual Desire Disorder

This is the deficiency or absence of sexual fantasies and desire for sexual activity.

Sexual Aversion Disorder

Aversion to and active avoidance of all or almost all genital sexual contact with sexual partner.

Sexual Arousal Disorder

Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication swelling response of sexual excitement.

Orgasmic Disorders

Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase.

Sexual Pain Disorders

  • Dyspareunia: Genital pain that is associated with sexual intercourse
  • Vaginismus: Recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal penetration with penis, finger, tampon, or speculum is attempted.

How is female sexual dysfunction treated?

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Most women who suffer from FSD benefit from a treatment approach that includes addressing both medical and emotional issues. Sometimes a medical solution can be the answer. Your doctor may try vaginal estrogen therapy, or if you are taking antidepressants, changing from one medication to another.

Behavioral treatments, such as stress management or couples therapy can help in the treatment of female sexual dysfunction. Most often, a combination of both works the best.

Non-medical treatment for female sexual dysfunction

  • Communication: Improving your communication is essential to developing better sexual health. Many couples do not talk about sex and the difficulties they are experiencing. They find it difficult to talk about such sensitive and intimate subjects, but talking about it can help. Talk to your partner. Listen to your partner. An open and honest dialogue can make a huge impact in your sex life.
  • Healthy lifestyle habits: Use alcohol in moderation because it can dull your sexual response. Smoking can restrict blood flow, and the less blood that reaches your sexual organs, the less chance you have for arousal and orgasm. Regular exercise can help boost your endurance, improve your mood, and generally make you feel better about yourself. Also, learning to relax and avoiding stress can improve your ability to focus on your sexual experience. All these can help you achieve greater arousal and orgasm.
  • Counseling: Find a qualified therapist in your area, one who focuses on sexual and relationship problems. Therapy can include sex education, ways to be more intimate with your partner, and suggestions for couple’s exercises. Various literature can also be helpful in learning different techniques and ideas for building a more intimate relationship with your partner. A therapist can be helpful in assisting you to better understand where your sexual beliefs and attitudes originate. These can be a key to identifying your sexual dysfunctions.

Medical treatment for female sexual dysfunction

Certain medications can have sexual side effects, particularly medications for anxiety and depression. Changing or adjusting these could make a difference. Also, hormonal imbalances or other medical conditions can affect your arousal and orgasm. Be sure to talk with your doctor about pelvic pain or other genital pain you may be experiencing.

Hormone therapies:

  • Estrogen therapy: This could be in the form of a vaginal ring, cream or tablet, which can aid in lubrication, tone, elasticity and even increase blood flow. Estrogen can also have a positive effect on brain function and mood issues.
  • Androgen therapy: This treatment consists of male hormones, such as testosterone. Although the presence of testosterone is minimal in women, they nonetheless need a certain amount for adequate sexual function. Androgen therapy is still somewhat controversial, but some women have been shown to benefit from this therapy. It can be given as a cream or pill.

The best therapy for female sexual dysfunction is to resolve both physical and emotional factors. Female sexual dysfunction is so complex, that no medicines or hormones will help until you address both of these first.

The physicians at Premier Medical Group Urology Division work with several therapists in the Poughkeepsie area, who specialize sexual communication.

Frequently Asked Questions

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I can’t seem to have an orgasm with intercourse. Why not?

In many women, the position and stimulation of the clitoris during intercourse is not adequate for orgasm. It is estimated that only 30% of women achieve orgasm through intercourse alone. The clitoris needs proper stimulation in order for most women to have an orgasm. There are many alternatives for you such as manual stimulation – either by you or your partner – oral sex, or even a vibrator. Sometimes the combination of these different ways of stimulation will allow the couple to enjoy intercourse and also allow the woman to reach an orgasm.

I’ve never been able to have an orgasm. Is there anything I can do?

There is more to sex than an orgasm. Many couples enjoy the closeness of intimacy. Just know you are not alone if you have never experienced orgasm; it is something that can be learned. Does this mean “never” by any method of stimulation including, manual or oral stimulation, masturbation, vibrator, or intercourse. Before you say never, try all the alternatives.

Why can’t I achieve an orgasm?

Insufficient blood flow to the vaginal area can contribute to female orgasmic problems. This could be due to poor circulation, low hormone levels, and lack of lubrication. The clitoris needs to become engorged in order to attain orgasm. There are creams that enhance blood flow to the vagina and there is also an FDA approved device that acts like a vacuum to help the clitoris. Exercising helps improve blood flow, as does better lubrication. Medications can affect orgasm, in particular antidepressants. With some women, it’s purely psychological and sex therapy can help. And for others, orgasm needs to be learned. Most of us, women and men, first learn to experience orgasm through self-stimulation (masturbation). You need to be patient and not rushed or stressed. The mind needs to work with the body. This is where a sex therapist can help you.

Why don’t we have Viagra for women?

Usually, arousal problems in women can’t be treated with a pill. They differ from a man’s erectile dysfunction and so far no pill exists for women.

Are there any research studies available for FSD?

Yes, Premier Medical Group Urology Division has a full time research division, which has successfully participated in several FSD studies in our Poughkeepsie office.