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FEMALE SEXUAL DISORDERS : DO YOU HAVE A PROBLEM ?
WARNING : For an accurate diagnosis leading to an effective therapy, a trusting and open relationship with your gynaecologist is vital! Only by looking at a complete clinical history and carrying out the necessary examinations, can he/she prescribe a suitable therapy. The following information is written here to broaden your own personal knowledge and ease the communication with your own physician. It is not a substitute for an honest and direct doctor-patient relationship. This said, enjoy the reading!
A FOREWORD ABOUT WOMEN'S COMPLEXITY
The female sexuality is
MULTIFACTORIAL: it depends on
DIFFERENT FACTORS:
-
Biological: a (reasonably) healthy body is a necessary, although not a sufficient condition, to enjoy sex
-
Psychosexual: previous positive or negative experiences of love, from infancy onwards, may deeply modulate the attachment dynamics, ie the way a woman approaches intimacy, her possibility to trust or not, to feel safe or not in a sexual context, to let herself go, to enjoy pleasure with or without guilty feelings, self confidence and even satisfaction with body image. Quality or absence of sexual education do modulate as well her erotic skills and scripts, her ability to be aware and empowered to protect herself against unwanted pregnancies and Sexually Transmitted Diseases (STD), her self confidence in sexual matters.
-
Context-dependent:related either to partners' health and sexual problems, couple dynamics, as well as to family problems and larger interactions with the social context, including work issues.
It is also
MULTISYSTEMIC: ie it requires the integrity and appropriate function of:
- hormones
- vessels
- nerves
- muscles
- immunitary system etc.
Last but not least, it shows a great variability according to
life stages and related experiences; just think about the physiologic, ie normal, changes of sexual drive and experience across pregnancy, puerperium, family problems, menopause…
WHAT ARE THE FEMALE SEXUAL DISORDERS?
The recently convened "International Consensus Development Conference on Female Sexual
Dysfunction", held with the contribution made by an interdisciplinary consensus
conference panel, consisting of 19 world experts in FSD, classified the leading
FEMALE SEXUAL DISORDERS as:
I) Sexual desire disorders:
- a) Hypoactive sexual desire disorder
- b) Sexual aversion disorders
II) Sexual arousal disorders
III) Orgasmic disorders
IV) Sexual pain disorders
- a) Dyspareunia
- b) Vaginismus
- c) Other sexual pain disorders
Subtyping further differentiates the diagnosis of FSD according to:
- a) the
temporal onset: "lifelong versus acquired".
This means that every woman should be able to precise to her physician if the sexual disorder she is complaining of was present from the very beginning of her sexual life, or appeared after months, years or decades of sexual well being
-
b) the
context-dependent dynamic: "generalized versus situational".
This means that every woman should precise if she is noting that the sexual complaint is
present in every situation and with different partners
(if she has or has had more than one).
The generalized
disorder may have biological as well as psychosexual causes, whilst the
situational
one is usually more dependent on relational and/or context dependent factors
-
c)
the etiology, classified as "Organic, Psychogenic, Mixed, Unknown". In comparison to previous classifications, the latter is the principal change, as it makes mandatory to explore the biological side of FSD for a full diagnosis. This acknowledges that - for women as well as for men - an healthy, functional body is a necessary, although not a sufficient condition, for a satisfying sexual response, particularly around and after the menopause, when a number of biological factors -endocrine, vascular, metabolic, muscular, neurological, connective and immunitary - may affect the general health and combine to worsen the physical potential of a full sexual response. This certainly does not refute the importance of intimacy and love issues, of psychodynamic and interpersonal factors that seem to be more critical in contributing to sexual satisfaction in women, but puts them in perspective in relation to the biological scenario.
Definition of different FSDs and paying attention to the subtyping may help your physician in correctly approaching the complaint(s).
Basson, R., Bertian, J., Burnett, A. Graziottin A. et Al. Report of the International Consensus Development Conference on Female Sexual Dysfunction: Definitions and Classifications. J.Urol, March 2000; 163:888-93
Bancroft J. Graham CA McCord Conceptualizing Women's Sexual Problems JSMT 27:95-103,2001
Due to the complexity of women's sexuality, special attention should be paid to:
1)
dedicate a balanced attention to different potential cofactors (biological, psychosexual, contextual) avoiding an excessive "medicalized thinking" , on one side, or "psychologized thinking" on the other, thus perpetuating a fracture between a "medicine without soul" and a "psychology without body"
2) maintain a
meaning-centered besides a function-centered perspective
3) avoid
error of commission, like mistaken claims focused on the "correct genital performance": women have a more comprehensive and "full-body and mind" approach to intimacy!
4) avoid
error of omission: that may induce to leave out too much from the sexual scenario. One should always pay attention to:
a) sexual motives, scripts, pleasure, sensuality,
emotionality, communication, connectedness
b) issues of power and gender
c) cultural variations in sexuality
Given the special attention to the menopausal transition, the focus of these pages will be most on the biological side, with the awareness that it should be put in context with psychosexual and contextual issues, including the cultural and gender ones.
L.Tiefer A new view of Women's Sexual problems: Why new? Why now? J. Sex. Res. 38 (2): 89-96, 2001
KEY MESSAGES:
- in women
co-morbidity, say co-existence of different sexual disorders, is increasingly reported after the menopause.
- this is easy to understand as
sexual hormones are the biological determinants af all dimensions of the sexual response
: sex drive, arousal with vaginal lubrication and vulvovaginal congestion and orgasm.
- without sexual hormones, sex drive may be reduced, arousal becomes more difficult as well as orgasm.
- most frequent female sexual disorders will be addressed in each dedicated chapter :
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