As a female medical practitioner, I am often asked by my female patients about causes of a decreased sexual desire. These women are both young and old, however no matter the age they feel that something is not normal since their sexual desires are diminished. They also note that this may be adding extra stress to their other activities at home especially in what they describe as a normal healthy relationship with a significant other. There are many factors that may be the root of the cause of sexual dysfunction so a thorough and honest health history and physical exam needs to be done.
The Female Sexual Response Cycle
To first understand what takes place during a female sexual cycle I have added the Masters and Johnson’s human sexual response cycle. A more clinical definition of the female sexual response cycle consists of four stages. The first stage is known as the excitement stage, which can be triggered by psychological or physical stimulation. This is noticeable by emotional changes which may include an increased heart rate, increased respiration, increased blood pressure and vaginal swelling with increased lubrication due to increased blood flow. Once the excitement stage is sustained it is now called the plateau stage, the second stage. In this stage there is vaginal swelling, heart rate, and muscle tension may increase as long as stimulation continues. During this stage the breasts enlarge and the nipples become erect. The third stage is the orgasm stage, which involves coordinated vaginal, anal, and abdominal muscle contractions, the loss of involuntary muscle control, and the feeling of intense pleasure. The final phase of these stages is known as the resolution stage which involves a rush of blood away from the vagina this in turn will start shrinking the breasts and nipples, and a cause a reduction in heart rate, respiration, and blood pressure.
There are no specifics to a normal or healthy response cycle. Women may experience these stages in varied ways for example, some women may progress from the excitement stage to the orgasm stage rapidly, while others may alternate between the plateau stage and the orgasm stage several times before reaching the resolution stage.
Causes Of Female Dysfunction
Causes of female sexual dysfunction are not clearly defined anywhere. There are several factors that may hinder the sexual response cycle, which requires both physical and psychological stimulation in order to take place.
More common reasons that sexual dysfunction may occur is due to depression, anxiety, stress, alcohol, smoking and illness. Other causes that are often seen with sexual dysfunction include the use of certain medications such as antidepressants, benzodiazepines, birth control pills and chemotherapeutic agents. If any of these drugs are used or any medication at all these may be the cause and a patient should disclose this information to their health care provider to help with diagnosing sexual dysfunction. Menopause or a hysterectomy may also diminish sexual desires as a result of reduced estrogen.
There are other theories that suggest sexual dysfunction such as medical conditions like diabetes and heart disease, again these should be investigated by a health care provider.
And finally there is the dissatisfaction theory which is neither psychological nor medical. This may occur due to lack of communication between partners where the sexual partner may not be able to stimulate the other partner to reach any of the stages of sexual function.
Diagnosing and Treating Sexual Dysfunction
Diagnosis of any sexual dysfunction should always start with an honest approach with the health care provider to avoid any unnecessary testing. Depending on what takes place during this visit and only after a thorough history and physical exam should further testing be done. Treatment will then be determined based on the results and the conversation between health care professional and patient
Sexual desire and activity should continue throughout our entire life. It is very important to note that this is part of everyday life and there should not be an interference with normal activities. There is help only if sought to help with sexual dysfunction.