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

Risk Factors For Female Sexual Dysfunction

Risk factors for female sexual dysfunction can be divided into two groups:

  • Organic risk factors, which include anatomic, physiologic, vascular, neural and hormonal factors. The mechanisms that lead to sexual dysfunction can be the result of clitoral and vaginal vascular insufficiency caused by surgical disruption of the iliohypogastric and Pudendal arterial bed. Disturbance and decreased blood flow and sexual dysfunction followed by decreased genital blood flow, which leads to smooth muscle fibrosis, vaginal dryness and dyspareunia[35];

  • Emotional and psychological risk factors include life stressors, past sexuality and mental health, such as the presence of anxiety and depression.

The association between anxiety and depression and altered female sexual function is well established. Data from a survey sent to 4000 men and women registered with four general practices in England indicated a strong significant association between FSD and depression and anxiety[36]. Participants answered questions related to demographics, social problems, health history and psychological status. The response rate was 44% (women: n = 979; men: n = 789). A total of 41% of women reported a current sexual problem. Arousal problems, dyspareunia, difficulty in achieving orgasm, inhibited enjoyment and vaginal dryness were all significantly correlated with depression and anxiety. The same study also found that arousal difficulties, difficulties achieving orgasm and inhibited enjoyment were significantly associated with marital difficulties in the female study subjects[36].

Another population study, a substudy of the National Health and Social Life Survey, conducted in 1992 provided data from a probability sample among 1749 women and 1410 men aged 18-59 years in the USA, representative for age, education level, and marital status. The data were obtained through face-to-face interviews conducted by trained interviewers[37]. The findings concluded that sexual pain was significantly associated with poor health status, emotional or stress-related problems and a 20% or more household income decrease. The latter two were also directly correlated with low desire and arousal disorder. Being forced sexually was directly correlated with arousal disorder. The authors concluded that emotional distress, social status and traumatic sexual experiences are among the important factors that negatively affect female sexual dysfunction.

The effect of hysterectomy on sexual function has been long debated. An excellent prospective randomized study on 279 women compared the effect of total abdominal hysterectomy versus subtotal hysterectomy on quality of life and sexual function 1 year after surgery[38]. The authors found that all participants had improved psychological symptoms following both types of hysterectomy compared with preoperatively, with no significant differences between groups. They concluded that hysterectomy, whether total or subtotal, may improve quality of life to the same degree. Another study describes the incidence and severity of sexual dysfunction after hysterectomy[39]. Factors that played a role on postoperative sexual function included preoperative sexual function, psychosocial state, degree of relief of symptoms by surgery, extent of procedure and surgical technique with regards to nerve and vessel sparing.


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