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Female Sexual Dysfunction

Sexuality is a significant aspect of overall health and well-being. Female sexual dysfunction often arises from pelvic floor dysfunction, influenced by childbirth in younger women and menopause in older women. Multiple factors, including biological, psychological, medical, interpersonal, and social elements, contribute to female sexual dysfunction, impacting the quality of relationships and life.

Human sexual function is complex, involving higher brain centers, hormones, and spinal reflexes. Key brain areas, like the prefrontal cortex, thalamus, and hypothalamus, are essential for sexual motivation and response. Sexual dysfunction can occur when any part of this system is impaired. Normal estrogen levels and intact nerve function are crucial for sexual arousal and vaginal lubrication in women.

Classification of Female Sexual Dysfunction

The prevalence of female sexual dysfunction varies, with estimates ranging from 25% to 63%, depending on the definition and population studied. Female sexual dysfunction can be classified into various types:

Hypoactive sexual desire
Sexual aversion
Sexual arousal disorders
Orgasmic disorders
Sexual pain disorders

Causes of Female Sexual Dysfunction

Neurological Causes:

Cortical Disease: Affects brain regions like the temporal and frontal lobes, leading to sexual disturbances.
Head Injury: Can cause hypoactive sexual desire or inappropriate sexual behavior.
Stroke: Often affects sexual function, especially with pre-existing conditions like hypertension or diabetes.
Epilepsy: Temporal lobe epilepsy can cause sexual manifestations, including hypersexuality.
Parkinson's Disease: Often leads to genital dysfunction.
Multiple System Atrophy: Can cause reduced genital sensitivity in women.
Spinal Cord Injury: Affects vaginal lubrication and orgasm.
Multiple Sclerosis: Commonly causes sexual dysfunction, with issues like loss of libido and decreased vaginal lubrication.
Diabetes: Can cause decreased vaginal lubrication and capacity for orgasm.

Non-Neurological Causes:

Physical Conditions: Can decrease sexual desire and ability to orgasm.
Hormonal Changes: Estrogen decreases can lead to less genital sensation and longer arousal times.
Psychological Factors: Anxiety, depression, and stress can contribute to female sexual dysfunction.
Social Factors: Cultural and religious issues, body image problems, and practices like female genital mutilation can affect sexual function.
Menopause: Leads to thinner vaginal lining and decreased sexual desire.
Postpartum Period: Hormonal shifts after childbirth can lead to vaginal dryness and decreased sexual desire.
Medical Conditions: Heart disease, pelvic floor dysfunction, and cancer can affect sexual function.
Medications: Blood pressure medication, antidepressants, and chemotherapy drugs can cause female sexual dysfunction.

Management of Female Sexual Dysfunction

Female sexual dysfunction should be managed with a holistic and multidisciplinary approach, involving both partners. Treatment options include:

History and Physical Examination: To evaluate sexual function.
Medical Conditions: Treating underlying conditions can alleviate symptoms.
Cognitive Behavioral Therapy: For individual and couples therapy.
Hormonal Medication: Testosterone and estrogen can help postmenopausal women.
Physical Therapy: Pelvic floor exercises can improve symptoms.

The Role of Physiotherapy in Women with Sexual Dysfunction

Women are at greater risk than men for health issues that affect sexual health. Physiotherapists help maintain and restore movement and function. They can assess movement impairments, functional capacity, and pelvic floor function. Assessment methods include inspection, palpation, and tools like electromyography and ultrasound. Pelvic floor muscle training can improve sexual function by strengthening pelvic floor muscles, increasing blood flow, and enhancing arousal and orgasm.

Addressing Social Stigma and Communication

Social stigma around female sexuality often makes women embarrassed to discuss their sexual health. Health professionals should be trained to discuss sexual health comfortably and accurately diagnose and treat sexual problems. The ALLOW model helps physical therapists initiate discussions and treat female sexual dysfunction:

A: Ask about the problem and sexual activity.
L: Legitimize the problem.
L: Identify limitations in physiotherapy assessment and management.
O: Open up discussion, including referrals to other disciplines.
W: Work together with the patient and/or partner.

Understanding and addressing female sexual dysfunction requires a comprehensive approach, considering the complex interplay of biological, psychological, and social factors. Physical therapists and other health professionals play a critical role in promoting sexual health and addressing issues related to female sexual dysfunction.

References: Bo, K., Berghmans, B., Mørkved, S., & Van Kampen, M. (Eds.). (2023). Evidence-Based Physical Therapy for the Pelvic Floor (3rd ed.). Elsevier.

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