Female Sexual Function and the Pelvic Floor

Sarit O. Aschkenazi;   Roger P. Goldberg


Expert Rev of Obstet Gynecol. 2009;4(2):165-178. 

In This Article

Defining Female Sexual Dysfunction

Intensive research into female sexual dysfunction during recent years has improved our knowledge of the biological, psychological and psychosocial factors that mutually influence sexual functioning. Several organizations have suggested different classifications of female sexual dysfunctions. The accepted definition today was endorsed following an interdisciplinary panel by the American Foundation for Urological Disease (AFUD), convened in 1998 to develop a classification system that would encompass the psychological and biological factors of FSD. Results from the panel were published in 2000[22]. The AFUD system encompasses biological and psychological factors, and most categories include a personal distress criterion. Furthermore, more than one dysfunction may be present and there may be interdependence among the disorders. These categories are undergoing continuous evolution, which reflects efforts to improve our understanding of the complexity of the female sexual cycle[101]:

• Sexual desire disorders
- Hypoactive sexual desire disorder (HSDD): the absence of sexual fantasies, thoughts and/or desire for, or receptivity to, sexual activity, which causes personal distress;
- Sexual aversion disorder: phobic aversion to, and avoidance of, sexual contact with a sexual partner, which must be persistent and causes personal distress.
• Sexual arousal disorder
- Female sexual arousal disorder: inability to attain/maintain sufficient sexual excitement, causing personal distress, which may be expressed as a lack of subjective excitement, or genital (lubrication/swelling) or other somatic responses;
- This definition of sexual arousal disorders recognizes that there is a wide range of physical and/or subjective reactions that can characterize female sexual arousal.
• Sexual orgasm disorder
- Female orgasmic disorder: delay in or absence of attaining orgasm following sufficient sexual stimulation and arousal, which causes personal distress;
- This definition of female orgasmic disorder entails the persistent difficulty, delay in or complete absence of orgasm that must be perceived as distressful.
• Sexual pain disorders
- Dyspareunia: genital pain associated with sexual intercourse;
- Vaginismus: involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration, which causes personal distress;
- Noncoital sexual pain disorder: genital pain induced by noncoital sexual stimulation and its relation to female sexual function is beyond the scope of this review.


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