This information was written by the education committee of the mental health program, caritas health group december /02
DISORDERS OF SEXUAL FUNCTION IN FEMALES Information for Patients and Families Mental Health Programs Grey Nuns Community Hospital & Misericordia Community Hospital
This pamphlet was written by Dr. Lorne Warneke of the Mental Health Program at the Grey Nuns Community Hospital, Caritas Health Group. June 2005
Reorder # 90285 What are the sexual disorders that commonly occur in
pleasurable sensation that is felt in the genital area,
females?
particularly in the muscles that surround the vagina,
but is also experienced as a warm and tingling
Sexual dysfunction can be classified as follows:
sensation that spreads throughout the body.
• The period of resolution is the time interval before a
female can become aroused to the point of orgasm
again. For some females this period is very short and
allows multiple orgasms to the single one experienced
The Human Sexual Response Cycle
Each of the phases of the sexual response cycle is distinct
Before describing the various disorders of sexual
with respect to the neurotransmitters (chemical
functioning, some information about the human sexual
messengers) that are involved as well as the part of the
nervous system that is involved. Dysfunction can occur
in any of the phases of the sexual response cycle leading
• The desire phase which includes interest in sexual
activity, and spontaneous sexual feelings.
Also, there are major differences between females and
• The arousal phase occurs after there is sexual interest
males when it comes to sexual desire and arousal. Males
and involves the reaction of the body. This includes
are more easily ‘turned on’ by the thought of sex, or a
increased heart rate, increased breathing, sweating,
visual cue, and become more immediately aroused and
flushing and, in the female, swelling of the genital area
usually wish to engage in sex very quickly. Females are
including the clitoris as well as the surrounding area.
more slowly aroused and are more likely to become
This is often referred to as the ‘orgasmic’ plateau. Of
desirous of sex and become aroused through interaction
interest, females have as much, if not more, erectile
with their partner. This difference is often a cause of
tissue than males. In the male the erectile tissue is
concentrated in the penis, whereas in the female this
includes the clitoris as well as the surrounding tissue.
Information About the Specific Disorders of Sexual
Because of the increased blood flow to the area, there
Functioning
is also secretion or lubrication which occurs in the
Overall about 43% of females have some degree of sexual
vagina. Other parts of the body may also swell and
become aroused, such as the nipples and the breast
Disorders of Sexual Desire
• The orgasmic phase is the actual orgasm and is
difficult to describe. For females it is an intense
This occurs in about 34% of females and is characterized
Female Orgasmic Disorder
by a very low or absent interest in sexual activity. It can
Inorgasmia is the condition in which an individual is
unable to achieve an orgasm or is able to do so only with
a great deal of stimulation and after a long period of time.
• Depression or other psychiatric illness, such as severe
This is in spite of adequate sexual interest and excitement.
It occurs in about 24% of females. This can be caused by:
• Low levels of testosterone which can occur in females,
• Some medications, such as antidepressants
2. Sexual Aversion Disorder- This is present when the
opportunity for sexual activity, or the thought of such
Sexual Pain Disorder
activity, creates feelings of revulsion or disgust and
1. Dyspareunia can be caused by any local problem
avoidance if possible. It is usually a learned response.
involving the vagina, such an infection, a cyst of the
Bartholin’s glands, Herpes lesions, prolapse of the
• Traumatic sexual experiences as a child or as an adult
• Strong puritanical views about sex that may have come
2. Vaginismus is a condition in which the muscles
surrounding the vagina contract as a reflex whenever
sexual penetration is attempted. If intercourse
Disorders of Sexual Arousal
continues to be attempted this can result in severe pain.
About 19% of females have problems with becoming
There can be various degrees of severity of
sexually aroused, that is, there is no swelling in the genital
area and no lubrication. This problem can be caused by:
• Any previous traumatic sexual experience in which
physical and or psychological pain was experienced
• As a result of this experience the muscles surrounding
• Severe anxiety about performing sexually – it can be
the vagina contract as a reflex to prevent this from
caused by a neurological problem, such as
complications of Diabetes or Multiple Sclerosis
• It may be due to testosterone deficiency, even in
Are There Treatments Available for the Sexual Disorders?
• It can be a side effect of medications, such as
The answer is yes. To begin with, it is important to talk
to your family doctor about the problem you are having. He will need to know if the problem occurs every time
sexual activity is attempted, or periodically. Is the
work if the individual has interest in sexual activity. It
problem recent, or has it been life long? What part of the
cannot be used if the individual is using nitrates for a
sexual response cycle is affected, and does the problem
occur with every partner (if there is more than one)?
• Cialis (tardanifil) is a drug very similar to Viagra, but
Does the problem occur during masturbation? Is there a
lasts longer, up to three days and is probably a drug
psychiatric or medical illness present and, if so, are
medications involved? Depending on the problem, a
• Levitra (vardenafil) is a similar drug to the other two
referral may be made to a specialist, such as a
gynecologist or even a psychiatrist that specializes in this
There are other drugs that are being studied, but are not
3. Orgasmic Disorders Specific Treatment Inorgasmia 1. Hypoactive Sexual Desire or Interest
This may be due to a number of factors, but is most
This can be a complex problem if it is due to
psychological problems and may require talk therapy to
antidepressants. It is important to discuss this with your
help the person deal with issues to do with their sexuality.
Sometimes the use of testosterone in a low dose can be
• Changing or lowering the dose of the medication, if
2. Disorders of Sexual Arousal
If this is due to anxiety, then counseling can be useful to
• Switching to a medication that does not have this side
enhance the person’s self-confidence. There are many
other psychological factors that can affect arousal.
• For some medications, stopping the drug for a couple
Couple’s therapy involving sensual massage (forbidding
of days will reverse this side effect long enough to
actual sexual activity for a period of time) can be useful,
focusing on foreplay. This can advance to more sexual
• There are a number of ‘antidotes’ that can be tried,
There are some medications that are useful for sexual
arousal problems in males. These drugs have not been
studied extensively in females, but there are reports of
them being helpful and are worth trying.
• Viagra (sildenafil) is a drug that helps with the blood
flow to the penis and would also increase the blood
flow to the genital area in the female. It will only
There are a specific set of exercises that a female can
Getting Help:
engage in to help with the problem of inorgasmia that
include a series of steps involving self massage that
The best place to start is to discuss your problem with
advances to self stimulation or masturbation,
your family doctor. If the family doctor is unable to
sometimes with the use of a vibrator. This is
provide help he or she will be able to refer you to a
important particularly for those females who have not
specialist in this area. The type of specialist may depend
had an orgasm before. The exercises are repeated with
on the nature of your problem and could include a
a partner. Pubococcygeal muscle exercises (also
gynecologist, urologist, psychiatrist, psychologist or
called Kegel exercises) can be useful. These muscles
social worker. The most important thing is to realize that
surround the vagina and contain nerve endings
help is available and to overcome any embarrassment that
important in orgasm. The exercises consist of bearing
down and contracting these muscles (squeezing the
anal sphincter tight) several times a day in a repetitive
4. Sexual Pain Disorder Dyspareunia This needs to be investigated by a physician and the underlying cause treated. Once treated, the pain with sexual activity usually goes away. Vaginismus This is a bit more complex to treat. Psychotherapy or talk therapy is required to address the fear of intercourse that has been developed. The reflex spasm of the pubococcygeal muscles can be overcome by the use of dilators that come in a range of sizes. The woman uses these dilators first until comfortable, and then the exercises are repeated with the regular sexual partner.
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