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Female Sexual Dysfunction

Female sexual dysfunction is a common yet under-researched issue affecting up to 46% of women, with few treatment options.

More common as women age, it's associated with a decrease in vaginal lubrication and arousal, discomfort or pain during sex, and difficulty achieving orgasm.

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What Is Female Sexual Dysfunction?  

Sex is an essential part of life, but female sexual dysfunction can diminish your quality of life. Many women are troubled when, at certain points in their lives, they don't enjoy sex, aren't interested in sex, or are unable to get aroused or achieve orgasm.

Doctors define female sexual dysfunction (FSD) as issues with one or more of these four areas involving sex:

  • Arousal
  • Desire
  • Orgasm
  • Pain

While male sexual dysfunction — including impotence and erectile dysfunction — has been studied extensively and effective treatments have been developed to treat their disorders, female sexual dysfunction is more complicated, isn't well-researched, and isn't well-understood.

It's also not routinely discussed with health care providers. Many women are uncomfortable talking about issues they're having with sex, and most doctors are unlikely to ask about it.

According to the American College of Obstetricians and Gynecologists, many doctors aren't adequately trained to diagnose and manage female sexual dysfunction. As a result, they devote inadequate clinical time to addressing FSD and underestimate how frequently the issue occurs.

How common is female sexual dysfunction? 

Female sexual dysfunction is a common yet under-researched problem affecting up to 46% of women. When sexual dissatisfaction or other problems not dysfunctional in nature are factored in, that number increases to as much as 75%.

What are the types of female sexual dysfunction? 

Hypoactive sexual desire disorder (HSDD)

With HSDD, you have a lack of desire — emotionally and/or physically — to have sex, and this low or absence of a sex drive causes you stress. It's the most common female sexual disorder, affecting up to 13% of women. 

Female sexual arousal disorders (FSADs)

FSADs are when you're unable to attain or maintain arousal and reach orgasm.

Included as FSADs are:

  • Orgasm disorders — When you're unable to achieve orgasm, even when stimulated and aroused.
  • Sexual pain disorders — Including dyspareunia (persistent genital pain with vaginal intercourse), vaginismus (persistent involuntary spasm of the outer vagina muscles that interferes with penetration), and noncoital sexual pain disorder (persistent genital pain caused by noncoital sexual stimulation).     

Other common causes of pain with sex include:

  • Endometriosis.
  • Pelvic inflammation or infection.
  • Vulvar disorders.

What causes female sexual dysfunction?

Sexual problems often develop at times when your hormones are fluctuating, such as shortly after giving birth or during perimenopause. Certain health issues, such as cancer, diabetes, and heart disease, can also play a role.

Other factors that contribute to sexual dysfunction include:

  • Physical conditions — Many health conditions can affect your sex drive and satisfaction. Some medications can also lower your libido and your body’s ability to achieve orgasm. These drugs include antidepressants, antihistamines, blood pressure medicines, and chemotherapy drugs.
  • Hormones — The drop in estrogen after menopause may cause your genital tissues to become thinner and less elastic, which may affect your sexual responsiveness and sensation. Changes in the vaginal tissue may make sex painful, particularly if you’re not sexually active.
    Hormonal changes can also make arousal and orgasm take longer to achieve. Shifting hormone levels after childbirth and during breastfeeding can lead to vaginal dryness, which can affect your desire to have sex.
  • Psychosocial issues — The demands and worries of being a new parent can contribute to depression or anxiety, which can cause sexual dysfunction, as can long-term stress and a history of sexual abuse. Relationship issues, cultural issues, religious taboos, and body image also decrease your sexual responsiveness. 

What are female sexual dysfunction risk factors and complications?  

Female sexual dysfunction risk factors

In a study of people with and without FSD, those with female sexual dysfunction were significantly more likely to:

  • Be age 40 or older.
  • Be married to men who were 40 or older.
  • Have been married for 10 years or more.
  • Have had three or more children.
  • Have sexual intercourse fewer than three times per week.

Interestingly, the study showed that smoking and using contraception didn't significantly affect the likelihood of a person having FSD.

Complications of female sexual dysfunction  

Female sexual dysfunction can strain your relationship with your partner and take a toll on your mental health.

In addition, several cardiovascular diseases have been linked with female sexual disorders, including:

  • Atherosclerosis — Hardening of the arteries.
  • Hypertension — High blood pressure.
  • Peripheral arterial disease — A narrowing or blocking of the arteries.

These same conditions are associated with aging and erectile dysfunction in men.

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What Are the Signs and Symptoms of Female Sexual Dysfunction? 

Symptoms of FSD vary based on the type of dysfunction you're experiencing. However, any symptoms of female sexual dysfunction are important to talk to your doctor about, especially if they're upsetting.

Persistent and ongoing symptoms to talk with your doctor about include:

  • Low sexual arousal — Although you may desire sex, you have difficulty becoming aroused or maintaining arousal during sex.
  • Low sexual desire — You have a lack of interest in sex or in being sexual.
  • Orgasm issues — You're unable to achieve orgasm after sexual arousal and ongoing stimulation.
  • Sexual pain — You have pain with sexual stimulation or vaginal penetration.

When should I see a doctor about my sexual dysfunction symptoms?

If sexual problems affect your relationship or cause you angst, make an appointment with your doctor for an evaluation.

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How Do You Diagnose Female Sexual Dysfunction?  

To diagnose female sexual dysfunction, your doctor will take a detailed health history. They'll want to know about the symptoms you're experiencing and when they started.

They may need to ask you highly personal, direct questions, including about your sexual history and your sexual identity and orientation to better understand your condition.

They may also ask you about:

  • Intrapersonal conflicts — Such as with sexual identity, guilt, religious taboos, extramarital affairs, partner differences in desire or practices, or poor sexual expression.
  • Your history — Including current or past physical, sexual, or verbal abuse; rape; or sexual inexperience.

Your doctor may perform a physical exam. If you're having pain during sexual intercourse, they may also do a pelvic exam.

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How Do You Treat Female Sexual Dysfunction?  

Not all forms of female sexual dysfunction need treatment. Some people can work around their sexual issues or are OK with not engaging in sexual activity at all.

But if sexual dysfunction is upsetting you, there are treatments that can help. The first step in treatment normally is to correct or address any underlying problems causing the dysfunction.

If the cause is physical, treatment will likely include medication or mechanical aids. If the problem is psychological, behavior modification therapy, counseling, and education may help.

Last reviewed by a UPMC medical professional on 2024-09-05.