Let’s talk about female sexual dysfunction

Sexual dysfunction affects nearly half of women worldwide and is not gender specific. In India, the problem gets worse as very few come forward to talk about it.

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According to a study published in the Indian Journal of Community Medicine in 2020, 82% of the patients who were surveyed had some sort of sexual problems.

Many women experience problems with sexual functions at some point, and some have difficulties throughout their lives. According to various reports, sexual dysfunction is reported by up to 45% of women worldwide, and approximately 12% (one in every eight women) have a sexual problem associated with personal or interpersonal distress. In India, sexual dysfunction among women is around 35%, and approximately 23% have a sexual problem associated with personal or interpersonal distress, say reports.

These figures reveal that sexual dysfunction is not gender specific and counter the popular belief that only men can face such issues. In India, the situation gets worse as very few women come forward to discuss such problems that may include little or no sex drive, trouble reaching an orgasm, or pain during intercourse. There is a taboo around sex in society and Indian women are reluctant and shy to discuss sexual problems unlike westerners who are more open and demanding when it comes to their needs.

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According to a study published in the Indian Journal of Community Medicine in 2020, 82% of the patients who were surveyed had some sort of sexual problems. However, 64% of the women could not talk regarding this to their partners. Only 18% of patients said that they had no sexual problems and were satisfied with their sexual life.

“None of them consulted or took any form of assistance from any medical personnel. The reasons they cited were that they were shy, thought it is normal, did not know if this problem can be treated or had compromised with the condition,” the study notes.

The study also found that 63% women reported desire dysfunction, 77% complained of arousal disorder, 51% had lubrication disorder, 56% had dyspareunia, and 74% had sex-related anxiety. When asked about the sexual frequency, only 4% of women had sex more than ten times in the past one month. “It is important to note that 78% of women knew the importance of sex in life. The reasons for decreased sexual activity were found to be ill health in 25% women, lack of privacy in 26% women, 32% women had other social reasons, 13% had lack of libido, and 3% had fear of pregnancy,” the study adds.

Incidentally, female sexual dysfunction can occur at any stage of life. “It can occur only in certain sexual situations or in all sexual situations,” says Dr Seema Sharma, senior consultant, obstetrics and gynaecology, Paras Hospitals, Gurugram.

Persistent, recurrent problems with sexual response, desire, orgasm, or pain are the symptoms that distress women or strain their relationship with their partners. “Sexual dysfunction signs include pain during intercourse, involuntary painful contraction (spasm) of the muscles around the vagina, lack of interest in (desire for) sex, and problems with arousal or orgasm. For a sexual dysfunction disorder to be diagnosed, these problems must cause distress to the woman,” explains Sharma.

Evidence and records indicate that a woman’s sexual function declines with age. “This decline begins in a woman’s late 20s to late 30s. Specifically, desire, frequency of orgasm, and frequency of sexual intercourse decrease with age. However, it is not clear whether arousal decreases or remains relatively constant,” adds Sharma.

“Problems with sex tend to increase as women age, but they can affect women at any stage of life. Sexual problems often develop when your hormones are in flux, such as after having a baby or during menopause,” further explains Dr Parinita Kalita, senior consultant—obstetrics and gynaecology, Max Super Speciality Hospital, Patparganj. “Sexual response involves a complex interplay of physiology, emotions, experiences, beliefs, lifestyle, and relationships. Disruption of any component can affect sexual desire, arousal or satisfaction, and treatment often involves more than one approach,” she adds.

Sexual dysfunction in women may have several physical or psychological causes. “Physical causes may include conditions like diabetes, heart disease, nerve disorders, or hormone problems. Some drugs can also affect desire and function. Psychological causes may include work-related stress and anxiety. They may also include depression or concerns about marriage or relationship problems. For some women, the problem results from past sexual trauma,” explains Dr Niti Kautish, director and HOD, gynaecology and obstetrics, Fortis Escorts Hospital, Faridabad.

Elaborating on the causes, Kalita of Max Super Speciality Hospital says any number of medical conditions, including cancer, kidney failure, multiple sclerosis, heart disease and bladder problems, can lead to sexual dysfunction. “Certain medications including some antidepressants, blood pressure medications, antihistamines and chemotherapy drugs, can decrease your sexual desire and your body’s ability to experience orgasm,” she says, adding: “Lower estrogen levels after menopause may lead to changes in your genital tissues and sexual responsiveness. The vaginal lining also becomes thinner and less elastic, so it becomes painful.”

Commenting on the psychological and social causes, Kalita says untreated anxiety or depression can cause or contribute to sexual dysfunction, as can long-term stress and a history of sexual abuse. “Long-standing conflicts with your partner— about sex or other aspects of your relationship—can diminish your sexual responsiveness,” she adds.

According to Kautish of Fortis Escorts Hospital, some factors may increase a woman’s risk of sexual dysfunction. “These are depression or anxiety; heart and blood vessel disease; neurological conditions, such as spinal cord injury or multiple sclerosis; gynaecological conditions, such as vulvovaginal atrophy, infections or lichen sclerosus; certain medications, such as antidepressants or high blood pressure medications; emotional or psychological stress, especially with regard to your relationship with your partner; or a history of sexual abuse,” Kautish says, adding: “If sexual problems affect your relationship or worry you, make an appointment with your doctor for evaluation.”

Women with sexual concerns most often benefit from a combined treatment approach that addresses medical as well as relationship and emotional issues. According to Kalita of Max Super Speciality Hospital, effective treatment for sexual dysfunction often requires addressing an underlying medical condition or hormonal change. “Your doctor may suggest changing a medication you are taking or prescribing a new one. You need to visit a doctor for proper diagnosis and medication including hormone therapy,” she adds.

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There are also some natural ways to boost sex drive or interest among women. The first is sex education. Sometimes, people can have mistaken beliefs about sex that prevent them from fully enjoying it. “For example, people may believe that the aim of all sexual activity is orgasm or that most females should be able to orgasm through vaginal penetration alone. So, any myths or misunderstandings should be cleared with proper sex education,” explains Dr Sapna Raina, senior consultant and robotic surgeon—obstetrics and gynaecology at Narayana Health City.

Women should talk to their partners about different ways to enhance desire and arousal. Consider making changes to your sexual routine. “You may also try erotic materials (sexual stimulation devices, videos or books), massage or masturbation,” says Raina, adding: “If an unresolved relationship problem could be affecting a person’s trust, desire, or attraction to their partner, then visiting a counsellor may help. Counsellors can act as mediators, allowing couples to have productive conversations and resolve issues.”

People with vaginismus can try dilator training, which involves inserting a smooth plastic dilator into the vagina while trying to relax the pelvic floor muscles. “Once a person feels comfortable with one size, they move up a size until they can have sex without pain,” says Raina.

Women can also try “some pelvic floor exercises, such as Kegels, which aim to strengthen the pelvic floor due to injury and weakness”, adds Raina.

Not Well

* 40%-50% women across the world report at least one manifest sexual dysfunction, irrespective of age

* As per a study published in Indian Journal of Community Medicine in 2020…

* 82% patients, who were part of the survey, said they had some sort of sexual problems

* 18% patients said they had no sexual problem, were satisfied with their sexual life

* 63% women reported desire dysfunction

* 77% complained of arousal disorder

* 51% had lubrication disorder

* 56% had dyspareunia

* 74% had sex-related anxiety

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First published on: 26-03-2023 at 01:15 IST