Essentials of Female Sexual Dysfunction from a Sex Therapy Perspective

Linda E. Ohl, MSW, CSW, ACH

Disclosures

Urol Nurs. 2007;27(1):57-63. 

In This Article

Overview of Female Sexual Dysfunction

Female sexual dysfunction (FSD) may be psychogenic or organic. However, unlike male sexual dysfunction, where the vast majority of cases are thought to be predominantly organic, current thought indicates a reverse situation in women. The majority of sexual dysfunctions in women are thought to be nonphysical.

However, recent research has associated medical conditions more frequently with sexual issues. Female sexual dysfunction has been linked to hypertension and its treatment (Burchardt et al., 2002), coronary artery disease (Salonia, Briganti, & Montorsi, 2002), and diabetes mellitus (Enzlin et al., 2002). The same vascular aberrations that cause erectile dysfunction in men associated with cardiovascular risk factors can cause arousal stage difficulties in women.

Effects of pelvic surgery and hormonal changes associated with menopause are known. Perhaps this issue may be viewed differently in the future, but currently FSD is diagnosed and treated primarily by therapists.

It remains important during the woman's initial evaluation to determine if there is evidence for the presence of an organic condition or if it seems psychogenic. While screening for organic causes, one should look for neurologic issues, cardiovascular disease, cancer, urogenital disorders, medications, fatigue, and hormonal loss or abnormalities.

Psychogenic causes include depression/anxiety, prior physical or sexual abuse, stress, drug or alcohol abuse, interpersonal relationship issues, such as partner performance and technique, or lack of partnership quality.

Social and cultural issues may also be contributing factors to FSD. Some cultures teach young women that sex is only for procreation, that sex is not to be enjoyed, or that the most important thing in a sexual encounter is pleasing the partner at her expense. Such issues are paramount in male-centric cultures. Religious upbringing may also influence attitudes toward sex and possibly lead to a psychogenic problem or other issues, such as lack of use of birth control measures by Catholics. Guilt related to diversion from literal religious teachings can exacerbate sexual dysfunctions. Evaluating a woman's sexual education, religious beliefs, family values, and societal taboos can help determine the root of the dysfunction.

Certain aspects of the onset and the particulars of the FSD may be helpful in determining whether it is organic or psychogenic. For example, acquired disorders, those appearing after a period of normal sexual functioning, may be associated with progression of medical diseases that contribute to the problem. Acute onset of a new dysfunction after a psychological stress is most likely psychogenic. Situational conditions (occurring only under some conditions, such as with a certain partner, but not others) are most likely psychogenic, whereas those that are persistent under all conditions are more likely organic. Younger women will most likely suffer a psychogenic problem, and older women with medical conditions and post-menopausal women are more likely to have an organic component.

It is also possible to have combined psychologic and organic disturbances. Even in the case where a medical condition is the primary cause of the problem, psychologic factors are often a secondary reaction to the primary cause. Patients may experience frustration or anxiety in approaching sexual activity, and this may further inhibit the sexual response via subconscious suppression. For example, a woman who has an organic cause of lack of lubrication may have pain during intercourse from dryness, leading to her frustration. Her partner becomes angry, and then she develops a fear that he may leave. During the next sexual encounter, her anxiety and fear is at the forefront of her thinking and the subsequent physical response to this further inhibits the ability to lubricate.

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