Sexual dysfunction in women

What are sexual dysfunctions in women?

Temporary sexual dysfunction occurs in many women. There are various reasons why women lose their desire for sex. The main triggers are tension, anxiety, fatigue, stress, insecurity, physical illness and problems in the relationship. However, the range of “normal” sexuality is wide. It is therefore difficult to say when a sexual disorder is actually present. No desire for sex is not automatically a sign that something is wrong in the relationship. Consult your family doctor or gynecologist if you feel insecure and the lack of desire is emotionally stressful.

Frequency of sexual dysfunction in women

According to the Professional Association of Gynaecologists (Germany), sexual dysfunctions occur relatively frequently:

• Almost one in three women has (temporarily) no desire for sexual activity.
• Around eleven percent report sexual arousal disorders.
• Ten percent find sexual intercourse unpleasant or experience pain during it.
• Every fourth woman feels inhibited during orgasm.
• Five percent have never experienced an orgasm.

Forms of sexual dysfunction in women

Doctors distinguish between different forms of sexual dysfunction:

• Changes in sexual desire (so-called appetite disorder)
• Disorders of sexual arousal
• Disorders caused by sexually induced pain:
  • Dyspareunia: Despite normal arousal, persistent genital pain occurs repeatedly before, during or after sexual intercourse.
  • Vaginismus (vaginal cramp): The vaginal muscles cramp involuntarily. This makes sexual intercourse impossible or very painful.
• Orgasm disorders

Definition of sexual dysfunction in women

A sexual dysfunction is present when the problems

• have existed for at least six months,
• are accompanied by suffering and
• sexual experience and behavior is impaired by a lack of, reduced or unwanted physical reactions.

Sexual dysfunction in women: causes and risk factors

Sexual dysfunction can be both psychological and physical in nature. Depending on which disorder is present, experts distinguish between different causes:

• Sexual dysfunction: Sexual dysfunction is predominantly physical.
• Psychosexual dysfunction: Sexuality is impaired primarily or exclusively for psychological reasons.
• Mixed forms: Sexual dysfunction can also occur as a result of (several) psychological and physical factors.

Physical causes

There are numerous possible physical causes of sexual dysfunction in women:

• Hormonal changes
• Changes originating in the nervous system
• surgical interventions in the area of the reproductive organs (e.g. removal of the uterus)
• Skin diseases of the vulva
• Diabetes mellitus
• Cancer diseases
• Rheumatism
• Parkinson’s
• other illnesses that impair sexual experience or behavior and are accompanied by pain (for example, illnesses, inflammation or scarred tissue in the urinary tract or genital organs)
• Vascular changes
• Menopause (leads to dry vagina)
• hereditary factors

Medication

Sexual dysfunction can also occur as a side effect of certain medications. These include

• Antidepressants,
• Beta blockers,
• Lipid-lowering drugs,
• Hormonal contraceptives such as the contraceptive pill can also lead to a lack of sexual desire.
• Hormone coil

Lifestyle

Lifestyle can influence women’s sexuality. Small amounts of alcohol seem to increase the desire for sex. In larger quantities, alcohol impairs a woman’s sexual arousal. The use of drugs such as marijuana or opiates can also lead to sexual dysfunction.

Mental causes

It is not uncommon for a woman’s sexual dysfunction to be caused by psychological problems. Typical psychological causes of sexual disorders are fears such as the fear of pregnancy or a sexually transmitted disease. Some women feel under pressure to perform when it comes to their sexuality or see themselves too critically. Insufficient knowledge about what happens during sexual intercourse, a lack of knowledge about one’s own body and misconceptions about sexual intercourse can also cause sexual dysfunction. In general, many different psychological factors have an influence on sexual experience and behavior:

• Stress at work
• interpersonal conflicts
• Family stress situations
• Depression
• Mental illnesses
• Mourning
• traumatic experiences
• Abuse
• bad experiences during sex

Partnership problems

Partnership problems can also lead to sexual dysfunction. Everyday arguments can have a negative impact on sexuality and lead to the woman no longer being able to enjoy sexual intercourse. Some women have problems showing their partner their sexual desires and needs. If these remain unfulfilled over a longer period of time, they find their sexuality unsatisfactory. A lack of empathy on the part of the partner can also mean that only one of them finds sexual intercourse satisfying and enjoyable. Women in particular often resign themselves to not experiencing an orgasm with their partner. In addition, changes such as the addition of a family or a monotonous daily routine in a long-term relationship can have a negative impact on sex life.

Symptoms: Recognizing sexual dysfunction

Depending on the phase of sexual activity in which a sexual dysfunction occurs, different symptoms will appear:

• Sexual desire disorder (appetence): A sexual desire disorder is characterized by a woman’s frequent or constant lack of desire: those affected feel harassed by their partner’s sexual advances and develop avoidance behaviour.
• Disorders of sexual arousal: In the arousal phase, the genital response is too weak or does not occur. This means that little or no vaginal fluid is produced despite sexual stimulation. This leads to pain during sexual intercourse.
• Disorders due to sexually induced pain: Despite arousal, genital pain occurs repeatedly before, during or after sexual intercourse (dyspareunia). Vaginismus causes the vaginal muscles to cramp, making sexual intercourse impossible or very painful.
• Disorders in the plate au phase: Sexual pain (stinging, burning and itching in the genital area) can also occur in the plateau phase.
• Disorders in the orgasm phase: Orgasm disorders affect the course or the subjective experience of orgasm. Some sufferers never or only rarely reach orgasm despite sexual arousal. Others experience a physiological orgasm without a corresponding feeling of pleasure.

Sexual dysfunction – diagnosis by us

In order to diagnose a sexual dysfunction, we first record the symptoms and their effects. We then conduct a psychological interview in which both physical and psychological factors are addressed. As a rule, a diagnosis can only be made if the patient confides in us openly. Possible questions are:

• How long have the sexual problems existed?
• Do you suffer from stress?
• Do you feel sexually under pressure to perform?
• How satisfied are you with your partnership?
• Have you had any negative sexual experiences?
• Do you have mental health problems?
• Do you suffer from depression?
• Have you been diagnosed with a vascular disease, diabetes, etc.?
• Are you going through the menopause?
• Are you taking any medications? If so, which ones?

Further procedure

We have various methods at our disposal to assess whether a sexual dysfunction is present:

• Physical examination: This serves to find out whether organic causes are responsible for the dysfunction (e.g. pain due to infections, consequences of surgery, injuries or anatomical abnormalities).
• Questionnaire: With the help of the questionnaire, we can systematically gather information about the woman’s sexual behavior and other aspects of the couple’s relationship.
• Psychodiagnostic interview: In a psychodiagnostic interview, we can find out whether there are psychological problems behind the disorder, such as depression or an anxiety disorder, and whether these are (partly) responsible for the sexual problems.

Sexual dysfunction in women: prevention, early detection, prognosis

As sexual dysfunction can arise for a wide variety of reasons, there is no general method you can use to prevent it. It is advisable to talk to your partner about sexual problems at an early stage. It’s also helpful to come to terms with your own body and personal sexual preferences.

Sexual dysfunction: Progression and prognosis

The treatment of sexual dysfunctions is very complex, as many different factors often interact. The problems often improve as part of couples therapy. The prognosis for vaginismus is also favorable. However, success depends heavily on the level of motivation and how well the partners work together. In extreme cases, talking psychotherapy can also bring to light fundamental couple conflicts and break up the relationship.

The sex therapists at the University Hospital Zurich offer appropriate counseling and work together with the doctors in the vulva consultation, dermatology and pain therapy departments, as well as physiotherapists who have specialized training in pelvic floor disorders.

Self-help groups

Sexual dysfunction: Treatment depending on the cause

The therapy used for sexual dysfunction is based on the cause.