Female sexual dysfunction, or female sexual dysfunction, is defined by the US Diagnostic and Statistical Manual of Mental Disorders, which is used internationally. The DSM is updated regularly according to the advancement of knowledge. The current version is the DSM5.
Female sexual dysfunctions are defined as:
- Female orgasmic dysfunction
- Dysfunctions related to sexual interest and sexual arousal
- Genito-pelvic pain / and dysfunctions of penetration
Main forms of sexual dysfunction in women
Difficulty reaching orgasm or lack of orgasm
It’s female orgasmic dysfunction. It corresponds to a significant change in orgasm: a decrease in the intensity of orgasm, an increase in the time required to achieve an orgasm, a decrease in the frequency of orgasm, or an absence of orgasm.
We talk about female orgasmic dysfunction if it lasts for more than 6 months and is not related to a health problem, mental or relational and if it causes a feeling of distress. Note that women experiencing orgasm by clitoral stimulation, but no orgasm during penetration are not considered to have female sexual dysfunction by DSM5.
Drop in desire or total lack of desire in women
This female sexual dysfunction is defined as a total cessation or a significant decrease in sexual interest or arousal. At least 3 of the following criteria must be met for dysfunction:
- Lack of interest in sexual activity (lack of sexual desire),
- A marked decrease in sexual interest (decrease in sexual desire),
- An absence of sexual fantasies,
- An absence of sexual or erotic thoughts,
- Refusals on the part of the woman to have sex with her partner,
- An absence of feeling of pleasure during sexual intercourse.
For this is really a sexual dysfunction related to sexual interest and arousal, these symptoms must last for more than 6 months and they cause distress on the part of the woman . Nor should they be linked to illness or the taking of toxic substances (drugs). This problem may be recent (6 months or more) or persistent or even continuous and exist forever. It can be light, moderate or important.
Pain during penetration and gynecopelvic pain
This disorder is described when the woman experiences recurring difficulties during the period of penetration for 6 months or more, as follows:
- Intense fear or anxiety before, during, or as a result of vaginal intercourse
- Pain in the small pelvis or vulvovaginal area during vaginal intercourse or when attempting intercourse with vaginal penetration.
- Marked tension or contraction of the pelvic or lower abdominal muscles during attempted vaginal penetration.
To enter this framework, we exclude women with non-sexual mental disorders, for example a state of post-traumatic stress (a woman who could no longer have sex after a wait-and-see does not fall into this category). relational distress ( domestic violence ), or other important stress or illness that may affect sexuality.
This sexual dysfunction can be mild, moderate or severe and last forever or for a variable period (but always more than 6 months to get into the official definition).
Often, situations can sometimes become entangled. For example, loss of desire can lead to pain during intercourse, and sex may be the cause of an inability to reach orgasm, or even a decline in libido.
States or situations causing sexual dysfunction
Among the main ones:
The lack of knowledge about sexuality.
And the lack of learning as a couple. Many people think that sexuality is innate and everything should work perfectly right away. It is not so, sexuality is gradually learned. One can also note a rigid education having presented sexuality as prohibited or dangerous. It’s still very common today.
Wrong information distilled by pornography.
Today pervasive, it can disrupt the establishment of a serene sexuality, lead to fears, anxieties, even practices that are not conducive to the gradual development of a couple.
Difficulties in the couple.
Unresolved conflicts with the partner often affect the desire to engage in sexual intercourse and to be intimate with one’s partner.
Latent or unrecognized homosexuality
This can have consequences on the course of sexual relations.
Stress, depression, anxiety.
Nervous tension generated by concerns (this includes wanting to please and satisfy your partner), stress, anxiety or depression usually reduces sexual desire and carelessness.
Attacks, sexual assault or rape
Women who have experienced sexual abuse in the past often report experiencing pain during sex.
Health problems that affect the genitals or related.
Women who have vaginitis , urinary tract infection , sexually transmitted infection, or vestibulitis (inflammation of the mucous membranes surrounding the vaginal entrance) experience vaginal painduring intercourse due to discomfort and dehydration mucous membranes that these affections provoke.
Women with endometriosis often have pain during intercourse. Having an allergy to certain fabrics used in the manufacture of underwear, spermicide or latex condoms can also cause pain.
These difficulties, even neat, can lead to sexual difficulties long after. Indeed, the body has a memory and can be afraid of sexual contact if it has had painful medical contacts.
Chronic illness or taking medication.
Serious or chronic illnesses that greatly alter energy, psychological state and lifestyle ( arthritis , cancer , chronic pain , etc.) often have an impact on sexual passion.
In addition, some drugs reduce the flow of blood to the clitoris and genitals, making it more difficult to reach orgasm. This is the case of some drugs against high blood pressure. In addition, other medications may decrease the lubrication of the vaginal mucosa in some women: birth control pills, antihistamines and antidepressants. Some antidepressants are known to slow or block the onset of orgasm (in men and women).
Pregnancy and its different states also modify sexual desire
Sexual desire may be reduced in women who suffer from nausea, vomiting, and breast pain, or if pregnancy is anxious.
Beginning in the second trimester, sexual arousal tends to be higher because the bloodstream activates in the sexual region, just to train the child and feed him. This activation leads to increased irrigation and reactivity of the sexual organs. An increase in libido can result.
With the imminent arrival of baby and body transformations that are increasing, the mechanical gene (belly fat, difficulty finding a comfortable sexual position), can reduce sexual desire. Sexual desire naturally decreases after childbirth because of the collapse of hormones. This results in a total blockage of desire in most women for at least 3 to 6 months and a vaginal dryness often important.
Moreover, because childbirth stretches the muscles involved in orgasm, it is advisable to perform perineal muscle training sessions prescribed by the doctor after childbirth. This helps to find more functional orgasms faster.
Decline of sexual desire at menopause.
Estrogen hormones and testosterone – women also produce testosterone, but in less quantity than men – seem to play an important role in sexual desire . The transition to menopause , decreases the production of estrogen. In some women, this causes a drop in libido and especially, gradually in a few years, this can cause vaginal dryness. This can create an unpleasant irritation during sex and it is strongly advised to talk to your doctor as there are currently solutions to this problem.
|Female sexual dysfunction: a new disease to treat?
In relation to erectile dysfunction in men , sexual dysfunction in women has not been the subject of so many clinical trials. Experts do not fully agree on the prevalence of sexual dysfunction in women. Because it is actually several very different sexual difficulties gathered in a large entity.
Some hold up results of studies that suggest that almost half of women would suffer. Others question the value of these data by pointing out that they come from researchers looking for lucrative new opportunities for their pharmaceutical molecules. They fear the inappropriate medicalization of disorders that are not necessarily medical 2 .
Symptoms of female sexual dysfunction
The decline of desire, the first sign of female sexual dysfunction:
- Unexplained and prolonged disappearance of sexual desire;
- Sometimes, repulsion for sexual activities.
- Absence of sexual thoughts, sexual fantasies, erotic imagination.
- Absence of erotic dreams.
Absence or difficulty in reaching orgasm
- The systematic or frequent failure to reach orgasm is one of the symptoms of female sexual dysfunction.
Pains during penetration
- Superficial pain at the entrance of the vagina;
- Deep pain during penetration;
- Some women have involuntary painful contractions of the vaginal muscles during penetration attempts, a problem called vaginismus .
Prevention of female sexual dysfunction
How to reduce pain during penetration?
- Have good personal hygiene to prevent vaginitis . However, never practice douching.
- Protect against urinary tract infections . Wipe from front to back after bowel movements, and urinate after having sex. See our page Urinary infection;
- Protect yourself against sexually transmitted infections (STIs): syphilis, chlamydia, gonorrhea, etc. Wear a condom (condom) during sex.
- Be knowledgeable about sexuality (educate children and adolescents and protect them from pornography)
- Follow psychotherapy or sex therapy if you have been touched, abused or raped in the past.
- Read the leaflet of the medicines you take and see if sexual difficulties are reported.
- Have a good lifestyle (physical exercise, weight control, balanced diet, adequate sleep, no tobacco or drugs, and little alcohol) because it plays on all areas of sexuality desire, such as pleasure.
How to maintain sexual desire and increase pleasure?
- Maintain good communication with the spouse
- Mention explicitly to his (or her) partner which specific caresses are pleasing;
- Show imagination and fantasy;
- After menopause , attitudes and expectations about sexuality are probably more important factors for sexual satisfaction than the decline of hormones. It is quite possible to maintain a beautiful sexual vitality by cultivating a positive and open attitude.
How to avoid pain related to vaginal dryness?
- Use a lubricant product;
- Take the time to arouse desire before penetration to increase the natural lubrication of the vagina ;
- Staying sexually active (possibly including masturbation): this improves vaginal lubrication and elasticity of vaginal tissues.
- Limit alcohol consumption;
- Quit smoking (see our smoking list);
- Exercise regularly
- Improve your ability to manage stress
- Sleep enough;
- Treat depression or anxiety as needed
- Visit your doctor regularly for routine tests;
- Since sexual relations are not only related to physical but also psychological factors, anyone who wishes to act in prevention must not exclude factors of emotional and relational health. Thus, a sex therapy could be indicated in case of worries or persistent discomfort.
To learn more about ways to enrich your sexuality , visit our Sexuality section. You will find in particular an interview with the sexologist Sylviane Larose: Put some spice: get out of bed!
The different treatments of female sexual dysfunctions
The first thing to do: consult your doctor
Always start with a checkup and a review of medications taken. This can be enough to find the cause of a sexual difficulty. Note that the contraceptive pill or antidepressants are regularly involved in disorders of sexual desire.
Physiotherapy: pelvic muscle rehabilitation
The physiotherapist or qualified midwife in perineal rehabilitation can be a help for some sexual difficulties.
In case of difficulty reaching orgasm, perineal muscle building can help regain orgasms, especially in women with children, but also in older women, even without children.
In cases of coital pain or vaginismus , work on pelvic floor muscles (the perineum) is often helpful. But it can only be realized after or in parallel with psychotherapy work in the case of vaginismus.
Treat the diseases involved:
When the dysfunction is attributable to a health problem affecting the genitals (vaginitis, urinary tract infection, sexually transmitted infection, etc.), appropriate treatment is possible and usually contributes to the return of a sex life. blossomed. Consult the cards corresponding to these affections to know more about their treatment.
Medications to treat a desire disorder
There is currently a drug, flibanserin, which has been marketed since 2015 as Addyi in the United States to treat acquired and generalized hypoactive desire disorders in premenopausal women. However, it is very controversial: in the study that allowed its commercialization, women on placebo had 3.7 sexual intercourse per month and women under Flibanserin 4.4, or 0.7 more sexual intercourse per month. On the other hand, adverse effects are common (36% of women in the study reported) with low blood pressure, drowsiness, syncope, dizziness, nausea or fatigue. (This medicine is from the antidepressant family).
Discover hormone therapy
Women who, in agreement with their doctor, choose the menopausal hormone treatment when they experience the first symptoms of menopause can decrease or even disappear their symptoms of dry vaginal mucosa. But this treatment is not effective in all women ..
To women suffering from a loss of libido related to hormone deficiency , the doctor could also prescribe testosterone , but little is known about the long-term effects of this type of hormone therapy and its use remains marginal and controversial. A testosterone patch (Intrinsa) was marketed, but it was removed from the market in 2012. It was allowed to women suffering from a decline in sexual desire and whose ovaries had been removed by surgery.
New treatments for female sexual dysfunction
– The fractional laser . It is used to treat vaginal dryness in women who can not or want to benefit from estrogen-like hormones. A thin probe is inserted into the vagina and sends painless laser pulses. This causes micro burns which, by healing, will stimulate the vaginal hydration capacity (we talk about vaginal revitalization). In three sessions spaced about a month apart, women regain comfortable lubrication. This method is also used at the vulvar level. It allows women who have undergone treatments for breast or uterine cancer to return to a comfortable sexual life. The vaginal laser vaginalis unfortunately not supported by the Health Insurance in France and the price of a session is around 400 €
– Radio frequency . A fine probe introduced into the vagina sends pulses of radiofrequency waves that cause a gentle warmth in depth. The woman feels a local warmth. This has the effect of tightening the tissues and boosting the vaginal lubrication capabilities. In 3 sessions at about 1 month intervals, women find a good lubrication, and also more sensations of pleasure and orgasms stronger and easier (thanks to the tightening of tissues), and very often see their small urinary problems disappear (tingling, small drop that annoys …). Radio frequency is not supported by the Health Insurance and it is at a price still high (about 850 € per session).
Why not make an appointment with a sexologist?
Sometimes, a multidisciplinary approach , which gives way to the intervention of a sexologist , makes it possible to treat sexual dysfunctions more effectively 5-7 . In Quebec, most sexologists work in private practice. These can be individual or couples sessions . These sessions can help to calm the frustration and tensions or marital conflicts caused by the difficulties experienced in the sexual life. They will also help to increase self-esteem, often abused in such cases.
The 6 approaches of a sex therapy:
- The cognitive behavioral therapy aims in particular to break the vicious circle of negative thoughts about sexuality (and the behaviors that flow from it) by identifying these thoughts and trying to defuse them; it also involves prescribing communication exercises or physical exercises for the couple. This approach to individual psychotherapy helps to explore and understand the problem by analyzing the person’s thoughts, expectations and beliefs about sexuality. These will depend on lived experiences, family history, social conventions, and so on. As examples of compelling beliefs: “the only true orgasm is vaginal” or “focusing on my desire to enjoy, I will reach orgasm”. This creates internal tensions that, on the contrary, decrease sexual satisfaction. In case of low libido or inability to reach orgasm, this is the preferred approach. It can also be useful in cases of coital pain, in addition to physiotherapy. Consult a psychologist or sexologist familiar with this approach.
- Trauma therapies. When a woman has suffered violence (intrafamily as a child, sexual violence, verbal abuse), methods currently exist to heal the psychic damage caused by these traumas: EMDR, life cycle integration (LCI), Brainspotting, EFT … are very active therapies.
- The systemic approach , which looks at the interaction of spouses and their effect on their sex life;
- The analytic approach , which attempts to resolve inner conflicts at the root of sexual problems by analyzing fantasy and erotic fantasies;
- The existential approach , where the person is led to discover his perceptions of his sexual difficulties and to get to know himself better;
- the sexo – corporal approach , which takes into account the inseparable links body – emotions – intellect, and which aims at a satisfactory sexuality as well on the individual level as relational.
Surgery has almost no place in the treatment of sexual dysfunction.
It can be practiced in women with endometriosis and penetration pain to eliminate the cysts involved.
In some cases of vestibulitis (intense pain between the two small lips at the slightest touch), some surgeons performed vestibulectomies. These surgical procedures are performed only when all other possible approaches have been exhausted without obtaining a satisfactory result.