No universal definition of normal sexual function exists, and what constitutes sexual difficulty is determined by a person’s objective definition of unsatisfactory sexual well-being.
The condition is described as an unsatisfactory interest, arousal, or orgasm or other aspects of sexuality.
Less than 50% of persons with sexual difficulties with that cause them distress seek help.
Low desire progressively increases with age, and sexually associated distress concurrently declines, so that the peak in hypoactive sexual desire dysfunction in women emerges during midlife.
Sexual dysfunction, negatively affects mental health, vitality, and social functioning, and has an effect on quality of life of similar in magnitude to that associated with chronic back pain or diabetes.
The term sexual dysfunction is used when at least one of the symptoms is of substantial concern to the affected person.
Prevalence 8-50% in women and refers to primarily low libido.
Female sexual dysfunctions are substantially undetected and under addressed, and often undocumented even when recognized.
The most common sexual difficulty with associated distress in women younger than 40 years, is poor sexual self image, observed in greater than 13% of women in this age group.
Distress related to sexual function is the hallmark of female sexual dysfunction.
Low sexual desire usually accompanied by low levels of arousal and excitement , infrequent organisms and sexual dissatisfaction.
It is recognized that sexual response is influenced by a complex interplay of biologic, psychological, and social factors, and it is no longer defined as either related to or caused by a disease or medication or independent of an identifiable cause.
While in association of cardiovascular risk factors with female sexual dysfunction has been suggested, it is mostly concluded that female sexual dysfunction is more strongly related to psychosocial factors.
Typical sexual phases of desire, arousal, orgasm and resolution overlap and the sequence can vary.
Sexual distress that occurs in sexual dysfunction is described as bothering, concern, unhappiness, frustration, anger, or hopelessness.
Sexual problems in women are more prevalent with age, but sexual distress decreases with age, making the prevalence of female sexual disorders approximately stable throughout the lifespan of women.
Sexual distress can manifest as distressing behavior as a reduced or absent initiation of sexual activity, avoidance of sexual situations, or participation in sexual activity without desire.
Prevalence increases after the third decade and after oophorectomy.
It may be lifelong or acquired after a period of normal functioning and situational or generalized, and related distress is characterized as mild, moderate, or severe.
Patients may experience multiple aspects of their sexual response problems and these may be concurrent.
Common after breast cancer diagnosis.
Sexual dysfunctions manifest as chronic sexual symptoms related to sexual pain and the three phases of sexual response cycle: desire, arousal, and orgasm.
Low sexual desire may be related to estrogen insufficiency symptoms, such as hot flashes, night sweats, mood changes, sleep disturbance, or vulvovaginal dryness.
Testosterone levels are independently associated with low orgasm satisfaction in pre-menopausal women.
Serum testosterone levels have not consistently been associated with sexual function in postmenopausal women.
Additional endocrine disorders associated with sexual dysfunction, include adrenal insufficiency, including adrenal suppression by systemic glucocorticoids, diabetes, and polycystic ovarian syndrome.
Chronic disease, conditions that reduce mobility or cause chronic pain, mental health conditions come, pelvic organ, prolapse, and cancer therapy may contribute to sexual dysfunction.
Psychological factors may underlie sexual dysfunction including relationship problems, poor self image, abuse, stressors, sociocultural beliefs, and expectations, depression, and psychotropic medication exposure.
The use of combined oral contraceptives, cardiac and anti-hypertensive medications may cause low sexual desire.
Female sexual dysfunction are distinguished by their persistence for a minimum of three months, occurrence with at least 75% of sexual experiences, and their association with sexually related personal distress.
Female sexual dysfunction may be lifelong or acquired after period of normal functioning and may be situational, psychological, interpersonal, and social and cultural risk factors.
More than half of patients with breast or gynecological cancer survivors report longstanding sexual side effects, often comprising physical and emotional well being.
Dyspareunia and vaginismus have been merged into a single category, genito-pelvic pain penetration disorder, and pain can occur with initial penetration, deep thrusting or with noncoital sexual activities.
Some women have persistent vulvar pain with provocation, known as provoked vestibulodynia.
Depression and marital status are independent predictors of female sexual dysfunction.
There is a bidirectional association between anxiety and depression and poor sexual function.
Most studies support the use of testosterone for impaired sexual desire disorders.
No androgen level is predictive of low female sexual function and the majority of women with low dehydroepiandrosterone levels do not have sexual dysfunction.
Associated with hypertension.
Metabolic syndrome is associated with decreased sexual activity, desire, and satisfaction in women.
Coronary artery disease is more prevalent in women with low sexual activity.
Thr management of sexual dysfunction is guided by the patient’s concerns as well as by their physical and psychological health and social circumstance.
Management of sexual dysfunction in females may also involve a partner.
Potentially modifiable factors such as medications known to be associated with sexual dysfunction, most commonly anti-depressants should be modified or changed.
Lifestyle interventions may reduce sexual difficulties: weight loss with obesity..
Psychosocial interventions in the form of sexual counseling, body awareness counseling, cognitive therapy, couples counseling, or psychological care or frequently effective in treating sexual dysfunction.
Targeted sexual therapy may involve pelvic floor relaxation training, vaginal dilator therapy, clitoral devices that it may improve sensation snd orgasm in women with an arousal disorder.
Hormone therapy is considered for menopausal symptoms.
Dyspareunia due to estrogen insufficiency can be treated with a local topical vaginal estrogen, cream, pessary, or ring; prasterone, oral ospemifene, or vaginal moisturizes.
Flibanserin and bremelanotide are approved for the treatment of premenopausal women with generalized, acquired hypoactive sexual desire dysfunction.
Flibanserin disinhibits pathways involved in sexual desire.
Its efficacy is modest showing an increased number of satisfying sexual experiences per month by 0.5, but with considerable side effects of dizziness, somnolence, nausea, and fatigue.
Bremelanotide is a melanocortin receptor agonist that increase dopamine release and increase excitation in brain regions associated with sexual desire.
It is associated with nausea, flushing and headache side effects.
Testosterone has been prescribed off label for hypoactive sexual desire dysfunction.
Transdermal testosterone may cause a small but significant increase in the likelihood of acne, growth of facial body hair, and weight gain, and long-term safety is lacking, but may be moderately affective for the treatment of postmenopausal hypoactive sexual desire dysfunction.