Did you know that 40% of women worldwide complain of issues with sexual function? Up to 43% of these women have issues with low sexual desire and up to 41% with an inability to achieve orgasm. These issues are all too common among women even though the media and pharmacology corporations devote much more time to male sexual dysfunction. This issue among females is way more common than one would think based on the little attention it receives.
Women often times want a quick fix to sexual issues; unfortunately it rarely is as easy as just taking a pill. Sexual dysfunction in women is often multifactorial. Causes can include psychological problems such as depression and anxiety, conflict within a relationship, fatigue, stress, lack of privacy, prior physical or sexual abuse, medications, along with other physical issues that may lead to pain with intercourse. Age can be associated with sexual dysfunction in women, but age alone is rarely the issue.
A common time to experience decreased libido for women include the postpartum period, after childbirth. While pain with initial intercourse after childbirth can lead to this, most of the time it is related to the stress of an enlarging family along with the fatigue associated with taking care of an infant. Pain with intercourse after childbirth can also be related to vaginal dryness that occurs frequently while breastfeeding. Another stage of life commonly associated with decreased libido is menopause. This is most commonly associated with vaginal dryness and painful intercourse related to decreased estrogen levels, as opposed to testosterone levels that many women try to blame. In fact, unlike estrogen that decrease with menopause, testosterone levels generally do not.
Some common diseases that have been linked with sexual dysfunction in women include high blood pressure, diabetes, depression and anxiety. This is related to both side effects of medications used to treat such medical issues as well as nerve disruption related to the diseases themselves.
Medications can be a major cause of sexual dysfunction in women. Some women experience decreased libido on one of the most common form of medication in women – birth control. This may be related to decreased testosterone production from the ovaries while on such medications. The solution may be as easy as changing your birth control to a type with a lower dose of estrogen. Antidepressants are another commonly used type of medication that is well known to decrease libido in women. Keep in mind that tobacco and chronic alcohol use are also factors in sexual dysfunction.
It is important to discuss with your doctor issues that you may have with sexual function. Work up for this problem involves evaluation of medical and surgical history, a thorough evaluation of medications and supplements that you may be taking, physical exam to rule out any anatomical changes that may be causing pain with intercourse and discussion regarding current and past sexual and relationship history. Rarely is lab work necessary in the workup, however on occasion a pelvic ultrasound, sexually transmitted infection cultures, blood counts, thyroid and prolactin levels may be appropriate. Testosterone levels are often drawn at the patient’s request, but rarely reveal any extra information to aid in treatment. Speaking about your problems with your physician is the best way to begin the path toward a solution and improved sexual life.
Depending on the issues surrounding the cause for sexual dysfunction, treatment/management may be multifocal. A treatment plan is very important. This often can include counseling with a couples and or sex therapist, pelvic floor physical therapy and/or psychotherapy. Lifestyle changes to decrease stress and fatigue can be very useful for women. Exercise regimens can be very rewarding in both aiding in overall health, decreasing overall fatigue and improving body image status for women. For women who have anatomical issues related to sexual dysfunction, water-based vaginal lubricants and vaginal dilators/stimulators can be very helpful.
The most commonly requested treatment for decreased libido in women is testosterone. The difficulty with this is that the blood levels of testosterone do not necessarily relate to libido status and therefore treatment is difficult to follow. There are currently no FDA approved testosterone treatments for women. Male medications are inappropriate for women and can have significant side effects. Commonly used testosterone replacement in women is a 1% compounded cream. This dose requires a prescription and is made by a compounding pharmacy, not FDA controlled. Injections and implants are also available, but not commonly used and when used often result in much higher levels than should be used in women. Keep in mind, adverse effects can occur from supplementation with testosterone in women. It’s use should be avoided in women with heart disease, liver disease, uterine hyperplasia or uterine cancer or breast cancer. Testosterone supplementation can also lead to acne, male pattern hair growth, deepening of the voice, and there is a possible link with breast cancer.
Sexual dysfunction can be caused by relationship issues, but can also be the cause of relationship issues. Don’t ignore it. Communication with your partner is very important in the process of improving libido. However, if symptoms persist and remain bothersome, please speak with your gynecologist.