Flipping the covers off female sexual dysfunction

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When I became a midwife I did not expect to discuss sexual dysfunction with my patients on a daily basis.

Menopausal women describe decreases in arousal and discomfort — not surprising given the physiological declines in estrogen that take place in this phase of life. More concerning are the women in their early twenties describing their disinterest in and aversion to sex.

These women rarely schedule an appointment with the sole purpose of discussing their sexual concerns. It's a problem most often mentioned after direct questioning about their sexual health. 

Many women are so embarrassed that they whisper their worries. Some are so distressed that they will cry while asking me if their problems are normal. 

Some women breeze over the topic with little concern, which means that by definition they do not suffer from sexual dysfunction. The issues must cause personal distress or relationship difficulties in order to fall under the heading of sexual dysfunction.

However they describe the issue, these women all want the same thing: a diagnosis and cure for their problem in a thirty-minute visit. They want me to run some labs and prescribe some mystical female equivalent of Viagra. Many women think testosterone is a magical solution — it is not.  

Certainly, some problems such as lack of lubrication or low estrogen levels are easy to correct with OTC products or prescription vaginal creams. Hormone replacement therapy is an effective option for some post-menopausal women. However, most female sexual disorders are more complex in nature, making quick treatment or management difficult.   

Chronic diseases such as diabetes or hypertension can contribute to sexual dysfunction. Stress, fatigue, depression and financial concerns are just a few of the psychological factors affecting sexuality.  Medications such as birth control pills and antidepressants are known to decrease libido. Quite often there are relationship issues that are the root cause of female sexual dysfunction. 

Clients who are not menopausal and have no obvious pelvic or genital problems on exam need further evaluation. Referring these patients for psychological or sexual therapy is appropriate.

When lack of desire is the problem, open and honest communication between a woman and her partner can help. Many couples fall into routines and are hesitant to express their need for more foreplay, experimentation or simply more time. A common complaint from clients is that they have no time for themselves, let alone for intimacy. Would time off from life's stressors improve these women's sex lives?

Female sexual dysfunction affects women throughout the lifespan and is a complex issue encompassing multiple disorders. In my experience, it is a rapidly expanding women's health concern. Researchers are constantly trying new medications and devices to treat some of the underlying causes of sexual dysfunction in women.  But there is no singular or easy “cure.”

Given the complexity of the problem, it is doubtful that a single treatment will emerge and be effective across the board. One client expressed her frustration with the lack of treatment available for women recently, "Men just take a pill and I need months of counseling — typical.”  

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