Female Sexual Dysfunction – Diagnosis and Treatment
Diagnosis
When a woman reports issues with sexuality or sexual functioning, healthcare professionals follow several steps to make a diagnosis.
First, the provider talks with the patient about medical history, sexual experiences, and any distress. This includes concerns like low sexual desire, difficulty with arousal, lack of orgasm, pain during intercourse, or other sexual complaints.
The provider also discusses psychological factors and relationship issues, since these can influence sexual response.
Next, the provider performs a physical or pelvic examination to check for changes in genital tissues, vaginal dryness, or scarring. These signs can be linked to arousal disorders, pain disorders, or vulvovaginal atrophy.
The provider may order blood tests to rule out medical conditions that affect hormones, sexual interest, or genital arousal.
Sometimes, the provider refers the patient to a therapist.
Common areas assessed include:
| Area Checked | What Is Assessed |
|---|---|
| Desire | Interest in sex, personal distress |
| Arousal | Physical and mental excitement |
| Orgasm | Ability to reach climax |
| Pain | Discomfort with intercourse (dyspareunia, vaginismus) |
By looking at these factors, providers get a full view of the patient’s sexual health and functioning.
Treatment
Lifestyle Changes and Counseling
Non-drug treatments help many people manage female sexual difficulties. Relationship and lifestyle factors often play a big role.
- Open Communication: Talking honestly with a partner about sexual needs can make a difference. Sharing feelings and concerns can help both partners feel closer.
- Healthy Habits: Regular exercise, eating well, and limiting alcohol may improve sexual function. Staying active and managing stress can help with mood and energy.
- Professional Counseling: A therapist or sexual counselor can guide individuals or couples with ongoing concerns. Therapy may include learning about sexual responses or trying new ways to connect.
- Lubrication and Moisturizers: Vaginal lubricants reduce dryness and make intercourse more comfortable. Moisturizers can ease dryness even outside of sexual activity.
- Staying Sexually Active: Engaging in sexual activity, alone or with a partner, boosts blood flow and comfort in the vaginal area.
- Devices and Tools: Vibrators and similar devices can increase stimulation and blood flow to the clitoris.
Table 1. Lifestyle and Counseling Approaches
| Approach | Examples/Tools |
|---|---|
| Communication | Talking about needs and boundaries |
| Healthy Lifestyle | Exercise, reduced alcohol, stress relief |
| Counseling | Sex therapy, cognitive behavior therapy |
| Lubrication/Moisturizer | Water-based gels, oil-based creams |
| Sexual Activity | Solo or partnered intimacy |
| Devices | Vibrators, clitoral stimulators |
Providers can combine these steps and tailor them to fit each person or couple.
Prescriptions and Medical Approaches
Medical treatments target physical causes or hormonal changes. Providers often use a tailored plan that may include medication along with emotional and lifestyle support.
- Vaginal Estrogen: Providers use low-dose estrogen as a cream, tablet, or ring in the vagina to relieve dryness and pain during intercourse. It can also help with some urinary issues.
- Selective Estrogen Receptor Modulator (SERM): This oral medication treats pain from vaginal thinning. People with a history or high risk of breast cancer should not use it.
- Testosterone Therapy: Providers may use testosterone off-label to address low sexual desire. No testosterone medications are approved specifically for women with sexual difficulties. Anyone considering this option should discuss risks, side effects, and possible benefits.
- Centrally Acting Serotonin Receptor Modulator: This daily oral medication is approved to treat low sexual desire in premenopausal individuals. Side effects can include low blood pressure, tiredness, dizziness, and nausea, especially if mixed with alcohol. If there is no improvement after eight weeks, the provider usually stops the medicine.
- Melanocortin Receptor Agonist: This medication is given as a shot under the skin before sexual activity to boost desire for premenopausal individuals. Common side effects include nausea, headache, flushing, and mild reactions at the injection site.
- Dehydroepiandrosterone (DHEA) Vaginal Insert: This daily vaginal insert provides a hormone called DHEA to help with dryness and pain during sex.
Table 2. Overview of Medical Options
| Treatment | Use | Notes |
|---|---|---|
| Vaginal Estrogen | Vaginal dryness, painful sex, urinary symptoms | Cream, tablet, or ring forms |
| Selective Estrogen Receptor Modulator (SERM) | Pain from vaginal thinning | Not for those with breast cancer history |
| Testosterone Therapy | Low desire (off-label use) | Must weigh risks and benefits |
| Centrally Acting Serotonin Receptor Modulator | Low sexual desire (before menopause) | Daily pill; monitor for side effects |
| Melanocortin Receptor Agonist | Low sexual desire (before menopause) | Self-injection before sexual activity |
| Dehydroepiandrosterone (DHEA) Vaginal Insert | Vaginal dryness, pain | Vaginal insert; hormone-based |
Sometimes, providers change other medications or adjust doses if a drug causes sexual side effects. Always talk to a healthcare professional before stopping or starting any medication.
Other treatment options include working with a physical therapist, especially if there is pelvic pain or tightness. Physical therapy can help relax and strengthen pelvic muscles.
New and Experimental Approaches
Some treatments for female sexual issues are still being studied or used in certain countries but are not widely approved.
- Synthetic Steroid Hormone Therapy: In some European countries, a synthetic hormone that mimics both estrogen and androgen effects has been used. Due to concerns about risks such as breast cancer and stroke, it has not been approved in many regions, including the U.S.
- Phosphodiesterase Type 5 (PDE5) Inhibitors: Medications commonly used for erectile dysfunction in men have been tested for female use. Results are mixed. Some women, especially those with sexual difficulty from antidepressants called Selective Serotonin Reuptake Inhibitors (SSRIs), may benefit. People on certain heart medications should not use this medicine.
- Alternative Hormonal Therapies: Researchers are studying hormones like progesterone and combinations of hormones for treating various symptoms.
Healthy Habits for Sexual Wellness
Making small changes in daily habits can support female sexual health. This is especially true with issues linked to menopause, aging, or medical problems like heart disease, arthritis, or breast cancer.
Staying active with regular exercise, such as walking or swimming, can raise energy and help you feel better about your body. This may make it easier to feel romantic.
Limiting alcohol and avoiding illicit drugs protects sexual function. Too much alcohol or drug use lowers sexual response and can cause health problems like urinary incontinence. Quitting smoking improves blood flow, which helps with arousal and sexual satisfaction.
Managing stress through relaxation techniques like yoga or deep breathing may also help. These actions are helpful for women facing hormonal changes, medical illnesses, or after events like childbirth.
Other Therapy and Complementary Approaches
Alternative treatments may help with anxiety, depression, relationship difficulties, and negative body image that can affect sexual health.
Cognitive behavior therapy (CBT) helps people change unhelpful thoughts and actions. This makes it easier to handle stress and emotional problems linked with sex.
Mindfulness involves focusing on the present moment and accepting thoughts and feelings without judgment. Mindfulness may lower stress and help people feel more comfortable in their bodies during sex.
Yoga uses stretching, breathing, and movement to relax the body and calm the mind. Some types of yoga aim to improve both mental well-being and sexual experience.
Herbal supplements and oils are sold for increasing libido and pleasure. These products have not been researched enough, and some may be unsafe.
Herbal items that act like estrogen may increase certain health risks, such as tumor growth. Always check with a healthcare provider before using herbal or topical products.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Being prepared helps you make the most of your visit with your healthcare provider.
Here is a checklist to consider before your appointment:
- Write Down Your Symptoms: Note when your issues happen and how often.
- Recall Your Sexual History: Include details about relationships, past sexual experiences, and any history of trauma or abuse.
- List Your Medical Background: Add all past and current health conditions, especially mental health concerns.
-
Prepare Questions: Write out anything you want to ask. Some common questions include:
- What could be causing my difficulties?
- Should I have any tests?
- What treatments are options?
- What might happen during treatment?
- Should I and my partner see a counselor or sex therapist?
Tip: Bringing this information helps your doctor or specialist better understand your situation.
What Your Healthcare Provider Might Discuss
During your visit, your provider will ask personal questions to fully assess your sexual health. They may ask about:
- How the problem affects your life and relationships
- How things are going in your relationship
- Whether you become interested or excited during sexual activity
- If you can reach orgasm, and if this has changed recently
- Any pain or discomfort during sex
- The use of birth control, hormones, alcohol, or recreational drugs
- Any surgeries involving your reproductive organs
Your provider might suggest your partner join the conversation in some cases. They may give you patient education materials or suggest referrals if you need specialist care.
Actions to Take While Waiting for Your Appointment
There are some simple steps you can take while waiting to see your healthcare professional.
Talk honestly with your partner about your concerns. Focus on non-sexual closeness, such as touch or quality time together. Set aside time for intimacy and try different ways to connect.
