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Sex is a motive force bringing a man and a woman into intimate contact. Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships. Though generally, women are sexually active during adolescence, they reach their peak orgasmic frequency in their 30 s, and have a constant level of sexual capacity up to the age of 55 with little evidence that aging affects it in later life. Desire, arousal, and orgasm are the three principle stages of the sexual response cycle. Each stage is associated with unique physiological changes. Females are commonly affected by various disorders in relation to this sexual response cycle. The prevalence is generally as high as 35-40%. There are a wide range of etiological factors like age, relationship with a partner, psychiatric and medical disorders, psychotropic and other medication. Counseling to overcome stigma and enhance awareness on sexuality is an essential step in management. There are several effective psychological and pharmacological therapeutic approaches to treat female sexual disorders. This article is a review of female sexuality.
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Indian J Psychiatry 57 (Supplement 2), July 2015
S296
INTRODUCTION
Sex is a motive force bringing a man and a woman into
intimate contact. Satisfying usual experience is an essential
part of a healthy and enjoyable life for most people.
Sexual activity is a multifaceted activity involving complex
interactions between the nervous system, the endocrine
system, the vascular system and a variety of structures that
are instrumental in sexual excitement, intercourse, and
satisfaction. Though essentially it is meant for procreation,
it has also been a source of pleasure, a natural relaxant,
it confirms one’s gender, bolsters one’s self‑esteem and
sense of attractiveness for mutually satisfying intimacy and
relationship.[1] The World Psychiatric Association has defined
sexual health as “a dynamic and harmonious state involving
erotic and reproductive experiences and fulfillment, within
Female sexuality
T.S. Sathyanarana Rao, Anil Kumar M. Nagaraj1
Department of Psychiatry, JSS Medical College, JSS University, 1Department of Psychiatry, Mysore Medical College and
Research Institute, Mysore, Karnataka, India
Address for correspondence: T.S. Sathyanarana Rao,
Department of Psychiatry, JSS Medical College, JSS University,
Mysore, Karnataka, India.
E‑mail: tssrao19@yahoo.com
Access this article online
Website:
www.indianjpsychiatry.org
Quick Response Code
DOI:
10.4103/0019‑5545.161496
Sex is a motive force bringing a man and a woman into intimate contact. Sexuality is a central aspect of being human
throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and
reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors,
practices, roles and relationships. Though generally, women are sexually active during adolescence, they reach their peak
orgasmic frequency in their 30 s, and have a constant level of sexual capacity up to the age of 55 with little evidence that
aging affects it in later life. Desire, arousal, and orgasm are the three principle stages of the sexual response cycle. Each
stage is associated with unique physiological changes. Females are commonly affected by various disorders in relation to
this sexual response cycle. The prevalence is generally as high as 35–40%. There are a wide range of etiological factors
like age, relationship with a partner, psychiatric and medical disorders, psychotropic and other medication. Counseling
to overcome stigma and enhance awareness on sexuality is an essential step in management. There are several effective
psychological and pharmacological therapeutic approaches to treat female sexual disorders. This article is a review of
female sexuality.
Key words: Anorgasmia, arousal, dyspareunia, female sexuality, vaginismus
REVIEW ARTICLE
ABSTRACT
How to cite this article: Sathyanarana Rao TS, Nagaraj AM.
Female sexuality. Indian J Psychiatry 2015;57:296-302.
a broader physical, emotional, interpersonal, social, and
spiritual sense of well‑being, in a culturally informed, freely
and responsibly chosen and ethical framework; not merely
the absence of sexual disorders.” This can be considered
the most comprehensive definition of sexual health as it
incorporates many domains like historical, physiological,
psychological, interpersonal, sociocultural, and ethical
views, including attention to human rights issues.[2]
Sexuality is a central aspect of being human throughout
life and encompasses sex, gender identities and roles,
sexual orientation, eroticism, pleasure, intimacy, and
reproduction. Sexuality is experienced and expressed
in thoughts, fantasies, desires, beliefs, attitudes, values,
behaviors, practices, roles, and relationships. While
sexuality can include all of these dimensions, not all of
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Indian J Psychiatry 57 (Supplement 2), July 2015 S297
them are always experienced or expressed. Sexuality is
influenced by the interaction of biological, psychological,
social, economic, political, cultural, ethical, legal, historical,
religious, and spiritual factors.[3] This article is a review of
female sexuality.
FEMALE SEXUALITY
In the first millennium BC, human cultures clearly experienced
a “axial period” in a striking transformation of human
consciousness. The transformation occurred independently
in three geographical regions: In China, in India and Persia,
and in the Eastern Mediterranean, including Israel and
Greece. In this cultural transformation, a prevailing mythic,
cosmic, ritualistic, collective consciousness embedded in
a tribal matrix with the female in the foreground, slowly
gave birth to a male dominated, rational, analytical, and
individualistic consciousness. This transition in cultural
values began very slowly after the last ice age retreated.[4]
In a developing country like India, modern Hindu cultures
even today contain a general disapproval of the erotic aspect
of married life, a disapproval that cannot be disregarded
as a mere medieval relic. Many Hindu women, especially
those in the higher castes, do not even have a name for
their genitals. Though the perception of modern Indian
women is transforming, many of them still consider the
sexual activity a duty, an experience to be submitted to,
often from a fear of abuse.[5]
According to Sigmund Freud, both sexes seem to pass
through the early phases of libidinal development in the
same manner. Psychologically, the male‑female difference
in sexuality starts only during the phallic phase, with
the appearance of Oedipus complex. However, the
difference becomes most clear only during the genital
phase.[6] Though generally, women are sexually active
during adolescence, they reach their peak orgasmic
frequency in their 30 s, and have a constant level of sexual
capacity up to the age of 55 with little evidence that aging
affects it in later life.[7]
Masturbation is a mode of sexual activity for both men and
women though it has been a source of social concern and
censure throughout the human tradition. It has been said that
99% of young men and women masturbate occasionally, and
the hundredth conceals the truth. In women, masturbation
can happen in many ways. Here the stimulation of the clitoris
is the central issue. Typically the hand and finger make circular,
back and forth or up and down movements against the mons
and clitoral area. Most women avoid direct stimulation
of the glans of the clitoris because of extreme sensitivity.
Some women thrust the clitoral area against an object such
as bedding or pillow, others by pressing thighs together
and by teasing the pelvic floor muscles that underlie the
vulva. Contrary to what is depicted in pornography, vaginal
insertion to reach an orgasm is not common. Some women
can reach orgasm by pressing the breast alone and a few
women (2%) by fantasy alone. Some individuals use vibrators
for added enjoyment and variation. By masturbation, many
women need <4 min to reach orgasm.[8]
THE SEXUAL RESPONSE CYCLE
Following the pioneering work of Masters and Kaplan, the
sexual response cycle in both sexes is often categorized
as a four‑phase process, desire, excitement, orgasm, and
resolution.[9]
The first stage, sexual desire, consists of the motivational
or appetitive aspects of sexual response. Sexual urges,
fantasies, and wishes are included in this phase. The second
stage, sexual excitement, refers to a subjective feeling of
sexual pleasure and accompanying physiological changes.
This phase includes penile erection in males and vaginal
lubrication in females. Plateauing, sometimes classified
as a separate phase, is a heightened state of excitement
attained with continued stimulation. There is marked
sexual tension in this phase, which sets the stage for the
orgasm. The third stage, orgasm or climax is defined as the
peak of sexual pleasure, with rhythmic contractions of the
genital musculature in both men and women, associated
with ejaculation in men. Graph 1 shows three different
patterns of orgasm in females. Pattern 1 shows multiple
orgasms. Pattern 2 shows arousal that reaches the plateau
level without going onto orgasm (note that resolution
occurs very slowly). Pattern 3 shows several brief drops
in the excitement phase followed by an even more rapid
resolution phase. This is the final phase, during which a
general sense of relaxation and well‑being is experienced.
Then, there is a refractory period in males, which is usually
absent in females. Table 1 shows the physical changes in the
female during the sexual response cycle.[10]
Graph 1: Different patterns of orgasm among females
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CLASSIFICATION
Based on the phases of sexual response cycle, both
International Classification of Diseases (ICD) 10 and
Diagnostic and Statistical Manual of Mental Disorders (DSM)
V have listed a variety of sexual disorders in women.
In ICD 10, the sexual dysfunction is classified under
F52, which is “sexual dysfunction, not caused by
organic disorder or disease.” In DSM V, there are several
modifications compared to the previous version that
is, DSM IV. Now it is segregated from gender identity
disorders and a separate chapter by name “sexual
dysfunctions” is elaborated in DSM V. With respect to
female sexuality, an important deviation from the earlier
concept is that the difficulties in desire and arousal often
simultaneously characterize the complaints of women.
Thus, the two entities are merged in DSM V. The sexual
desire disorder in women is not listed separately. It is now
called “female sexual interest/arousal disorder” and is
listed under arousal disorders. The Table 2 compares the
nosological status of sexual dysfunction in females among
the two diagnostic manuals.
EPIDEMIOLOGY
In general, there has been an acute dearth of valid or
reliable statistical data on the epidemiology of female
sexual disorders. This is particularly true when it comes to
nonwestern settings.
In a survey of the US general population, sexual dysfunction
was more prevalent in women (43%) than men (31%)
and was associated with various sociodemographic
characteristics including age and educational attainment.
Women of different social groups demonstrate a different
pattern of sexual dysfunction. The experience of sexual
dysfunction is more likely among women (and men)
with poor physical and emotional health.[11] In England,
a study asserts that about two‑fifths of women (41%)
reported having a current sexual problem. The most
common problems were a lack of desire, vaginal dryness,
Table 2: Comparison of no sociological status of sexual
dysfunction under ICD 10 and DSM V
ICD 10 DSM V
Lack or loss of sexual desire Not listed
Sexual aversion and lack of
sexual enjoyment
Not listed
Failure of genital response Female sexual interest/arousal disorder
Orgasmic dysfunction Female orgasmic disorder
Nonorganic vaginismus Vaginismus (not due to a general
medical condition)
Nonorganic dyspareunia Genito-pelvic pain/penetration disorder
Excessive sexual desire Not listed
Other sexual dysfunction not caused
by organic disorder or disease
Other specied sexual dysfunction
Unspecied sexual dysfunction not
caused by organic disorder or disease
Unspecied sexual dysfunction
Not listed Substance/medication-induced sexual
dysfunction
DSM – Diagnostic and Statistical Manual for Mental Disorders;
ICD–InternationalClassicationofDiseases
Table 1: Physical changes in the female during the
sexual response cycle
Sexual
response
cycle
Physiological changes
Desire phase Has no specic physical changes
Excitement Vaginal lubrication begins
Inner two-thirds of the vagina expands
Color of vaginal wall becomes darker
Outer lips of vagina atten and move back from the vaginal
opening
Inner lips of the vagina thicken
Clitoris enlarges
Cervix and uterus move upward
Nipples become erect
Breast size increases modestly
Sex ush appears (late and variable)
Heart rate and blood pressure increase
General neuromuscular tension increases
Plateau Vaginal lubrication continues, but may wax and wane
Orgasmic platform forms at outer third of the vagina
Cervix and uterus elevate further
Inner two-thirds of vagina lengthens and expands further
Clitoris retracts beneath the clitoral hood
Lips of the vagina become more swollen and change color
Sex ush intensies and spreads more widely
Further increase in breast size; areola enlarges
Heart rate and blood pressure increase further
Breathing may become more shallow and rapid
Voluntary contraction of rectal sphincter used by some
females as a stimulative technique
Further increase in neuromuscular tension
Visual and auditory acuity are diminished
Orgasm Onset of powerful involuntary rhythmic contractions of
orgasmic platform and uterus
Sex ush, if present, reaebxs maximum color and spread
Involuntary contractions of rectal sphincter
Peak heart rates, blood pressure, and respiratory rates
General loss of voluntary muscular control; may be cramp
like spasms of muscle groups in the face, hands, and feet
Resolution Clitoris returns to normal position within 5-10 s after orgasm
Orgasmic platform disappears
Vaginal lips return to normal thickness, position, and color
Vagina returns to resting size quickly; return to resting color
may take as long as 10-15 min
Uterus and cervix descend to their unstimulated positions
Areola returns to normal size quickly; nipple erection
disappears more slowly
Rapid disappearance of sex ush
Irregular neuromuscular tension may continue, as shown by
involuntary twitches or contractions of isolated muscle groups
Heart rate, respiratory rate, and blood pressure return to
baseline (preexcitation) levels
General sense of relaxation is usually prominent
Visual and auditory acuity return to usual levels
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and infrequent orgasm.[12] Another study from England
reports the prevalence rate of sexual dysfunction in
women as 42%, vaginismus was reported by 30% of them,
and anorgasmia by 23%.[13]
A recent cross‑sectional study from a different geographical
area (Iran) using Female Sexual Function Index (FSFI) also
found a similarly prevalent sexual problems in the range
of 22% (<20 years) to 75% (40–50 years). Problems with
desire were found with 45%, arousal problems in 37%, the
lubrication problem in 41%, the orgasmic problem in 42%
and pain problem in 42%. Some of the important associated
etiological factors were older age, infrequent sexual activity,
more than 10 years of marriage, more than three kids and
husbands more than 40 years. The authors consider that
the female sexual dysfunction is a significant public health
problem of women in that nation.[14]
The literature on etiological factors associated with
sexual dysfunction infers that in women, the predominant
association with arousal, orgasmic, and enjoyment
problems was marital difficulties. Vaginal dryness was found
to increase with age after menopause. In general, sexual
dysfunction was commonly associated with social problems
in women.[15]
SPECIFIC PROBLEMS
Sexual dysfunction includes disorders of (i) desire, (ii) arousal,
(iii) orgasm and (iv) sexual pain disorders.[16,17]
Disorders of sexual desire
It is explained as an independent entity in ICD 10 (and not
in DSM V as mentioned before). It includes lack or loss of
sexual desire, sexual aversion and lack of sexual enjoyment.
Lack or loss of sexual desire is manifest by the diminution of
seeking out sexual cues, of thinking about sex with associated
feelings of desire or appetite, or of sexual fantasies. There
is a lack of interest in initiating sexual activity either with
a partner or by masturbation. Sexual aversion is defined
as a disorder in which the prospect of sexual interaction
with a partner produces sufficient aversion, fear or anxiety
that sexual activity is avoided. In the disorder of lack of
sexual enjoyment, genital response (orgasm) occurs during
sexual stimulation, but is not accompanied by pleasurable
sensations or feelings of pleasant excitement.
It has been estimated that about 20% of the female
population have the hypoactive sexual desire. Chronic
stress, anxiety, depression, prolonged period of abstinence
from sex, hostility in relationship with partner, previous
bad experience with sex, childhood sexual abuse,
religious taboos, low biological drive, dysfunction of the
hypothalamic pituitary axis, endocrinal disorders, ovarian
failure, psychotropic, and cardiovascular drugs are the
various etiological factors associated with low sexual desire.
Disorder of arousal
The failure of genital response in females is experienced as
the failure of vaginal lubrication, together with inadequate
tumescence of the labia. However, a subjective sense of
arousal is often poorly correlated with it in that a women
complaining of lack of arousal may lubricate vaginally,
but may not experience a subjective sense of excitement.
There is also a lack of vaginal smooth muscle relaxation and
decreased clitoral enjoyment. Though, exact prevalence
is not known, about 35% of women report difficulty in
maintaining adequate sexual excitement. This dysfunction
causes marked distress in women. The etiological factors
include vasculogenic, neurogenic and endocrine factors,
systemic diseases, psychotropic drugs and psychosocial
factors.
Orgasmic disorder
Achieving orgasm adequately is highly treasured by
women as it is seen as a mark of high self‑esteem, and
confidence in one’s feminity resulting in a high desire
for sexual activity. Persisting and recurring difficulty
in achieving orgasm is termed as anorgasmia. The
appropriate, reported prevalence of this disorder is in the
range of 5–10%. Women who suffer solely form orgasmic
dysfunction may have normal desire and arousal, but have
great difficulty in reaching climax. However, the distress
over inability to reach orgasm may lead on to decrease in
desire and arousal.
Among the etiological factors for orgasmic disorders, the
organic factors include neurological conditions that affect
the nerve supply to the pelvis, like multiple sclerosis, spinal
card tumors or trauma, nutritional deficiencies, diabetic
neuropathy, vascular causes, endocrine disorders and
drugs like methyldopa, antipsychotics, antidepressants,
and benzodiazepines. An important psychosocial factor
implicated in orgasmic disorders is the negative cultural
conditioning. Specific developmental factors like traumatic
sexual experiences during childhood, negative attitude
toward sex and interpersonal factors like hostility toward
spouse are also implicated in orgasmic disorders.
Sexual pain disorders
These are of two types: (1) Dyspareunia (2) vaginismus.
Dyspareunia
Dyspareunia is defined as recurrent or persistent genital
pain before, during or after sexual activity. It can be divided
into superficial, vaginal and deep. Superficial dyspareunia
occurs with attempted penetration, usually secondary to
anatomic or inflammatory conditions. Vaginal dyspareunia
is pain related to friction. Deep dyspareunia is pain related
to thrusting, often associated with the pelvic disease.
The prevalence rate of dyspareunia reported in the literature
is anywhere between 4% and 55%. The reason for this wide
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range could be that many prevalence studies do not include
dyspareunia within their list of dysfunctions or fail to
distinguish it from vaginismus, as dyspareunia is related to
and often coincides with vaginismus. Dyspareunia should
not be diagnosed when it is primarily due to vaginismus or
lack of lubrication.
Traditionally the etiology of dyspareunia has been divided
into organic and psychological. The organic factors are
further divided into anatomic, pathologic and iatrogenic.
Anatomic factors are congenital factors like agenesis of
the vagina and rigid hymen. The pathologic factors include
multiple conditions like vulvar atrophy, cervical erosion,
fibroids, ovarian cyst, endometriosis, prolapsed uterus,
tender uterosacral ligaments, tender bladder, squamous
metaplasia, infections, etc., Iatrogenic factors are usually
the consequence of a surgical procedure like episiotomy.
The psychoanalytic and learning theories are the two major
psychological theoretical perspectives. The psychoanalytic
theory treats dyspareunia as a hysterical or conversion
symptom symbolizing an unconscious intrapsychic conflict
and considers dyspareunia to be a result of phobic reactions,
major anxiety conflicts, hostility or aversion to sexuality.
Learning theory posits that dyspareunia is attributable
to lack of or faulty learning which may contribute to a
woman entering sexual relations with a set of negative
expectations. Also developmental (attitudes toward
sexuality), traumatic (prior aversive coital experiences) and
relational (interpersonal disputes with a partner) factors are
the other psychological factors.
Vaginismus
It is a recurrent or persistent involuntary spasm or constriction
of the musculature surrounding the vaginal outlet and
the outer third of the vagina that interferes with vaginal
penetration. It causes severe personal distress. Women with
this disorder are even unable to insert tampons or permit the
insertion of a speculum during gynecological examination.
However, they can go through all stages of the sexual cycle
including arousal and orgasm. Vaginismus may be complete
or situational. This psychophysiological syndrome may affect
women of any age and most often afflicts highly educated
women and those in the higher socioeconomic status. Most
of these cases present as unconsummated marriage.
Vaginismus may be due to organic or nonorganic causes.
Most of the organic causes are lesions of the external
genitalia which lead on to vaginismus as a result of natural
protective reflex to pain. Among the frequent organic causes
are hymenal abnormalities, genital herpes, obstetric trauma
and atrophic vaginitis. Most commonly, however, no organic
causes can be implicated. Vaginismus is hypothesized
to be the body’s expression of the psychological fear of
penetration, hence shares features of a psychosomatic
disorder, phobia, and conversion disorder. Analytically
oriented theorists speculate that this disorder reflects the
women’s rejection of the female role or as a resistance against
a male sexual prerogative. Learning theory understands this
dysfunction as a conditioned fear reaction reinforced by the
belief that penetration can only be accomplished with great
difficulty and will result in pain and discomfort. A variety
of psychosocial factors may be operative, like religious
orthodoxy and regarding sex as dirty and shameful. Fear
of pregnancy, disgust regarding genitalia and homosexual
orientation are other causes. The diagnosis is arrived by a
careful history and unhurried methodical examination.
MANAGEMENT
Success in treatment depends on accurate diagnosis which in
turn depends on an elaborate sexual history and appropriate
examination. Biochemical and other investigations also
form an essential part of the evaluation. Serum levels of
prolactin, estrogen, progesterone, follicle‑stimulating
hormone and luteinizing hormone are most commonly
implicated. The doctor‑patient relationship and the patient
interview are however, the key aspect in management.
FSFI is a questionnaire that can be easily used by health
professionals to complement the diagnosis and to detect
treatment‑related changes. The FSFI recognizes the need
for a subjective criterion in defining sexual dysfunction
and determines, through the nineteen item answers,
five separate domains: (a) Desire/arousal, (b) lubrication,
(c) orgasm (d) satisfaction and (e) pain.[18] Another
questionnaire widely used is the sexual history form. This
instrument, through 28 items, evaluates the frequency of
sexual activity, desire, arousal, orgasm, pain and overall
sexual satisfaction for women and men.[19]
Apart from these general interventions, sexual health in
elderly women needs specific attention. Due to increase
in life expectancy and more than one consecutive sexual
partner, the couple expect being sexually active even after
65 years of age. However, age decreases the frequency of
genital sexual activity. This issue needs to be addressed.
The clinician should educate that the quality of relationship
and an understanding of the physical and psychological
changes due to increasing age play a key role in sexual
satisfaction in old age. Chronic ill health and other
psychosocial situation need to be addressed. Alternatives
techniques are encouraged for better sexual functioning.
Vaginal lubrication products are equally essential.[20,21]
Managing sexual desire disorders
Historically, attempts to treat hypoactive sexual desire
disorders typically followed the sex therapy prototype
developed in 1970s. However, recently researches
and practitioners have begun to explore concomitant
psychotherapies.[22]
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• Group therapy in conjunction with orgasm consistency
training, which consists of directed masturbation and
sensate focus exercises[23]
• A comprehensive program of multimodal cognitive
behavioral approach which entails sexual intimacy
exercises, sensate focus, communication skills training,
emotional skills training, reinforcement training,
cognitive restructuring, sexual fantasy training and
couple sex group therapy[24]
• Multistage treatment approach[25]
• Affectual awareness training: To identify negative
emotions through techniques such as list making,
role‑playing, and imagery
• Insight and understanding: To educate couples about
their feelings using a variety of strategies like gestalt
therapy and transactional analysis
• Cognitive and systemic therapies are included to
provide coping mechanisms as well as to resolve
underlying rational problems
• Behavioral therapy is aimed at initially improving
nonsexual affectionate behavior with an eventual goal
of introducing mutually acceptable sexual behavior
• If the organic pathology is treatable or controllable,
(e.g., by hormone replacement or stopping a particular
drugs which may cause disorders of desire) this should
be done
• Testosterone administration is the principle
pharmacological treatment for hypoactive sexual desire
disorder in women. However, the risks and benefits of
its administration are yet to be clarified[26]
• For disorders of sexual aversion, interventions are on
the some lines.
Management of disorder of arousal
The clinician should be able to delineate the disorders
of desire or orgasm which usually manifest as arousal
disorders. If the woman would have experienced arousal
by a particular way of stimulation, the partner should be
sensitized about it. Encouraging adequate foreplay or use
of vibrators to increase stimulation may be useful. Fantasy
training, use of erotic materials, attention‑focusing skills,
Kegel exercises (voluntary relaxation and contraction of
pubococcygeus muscles) and enhancing the partner’s
sexual skills are the other useful female arousal facilitation
techniques. Anxiety may inhibit arousal and strategies to
alleviate anxiety by employing distraction techniques are
helpful.[16]
Pharmacological treatment is also found to be useful in
female arousal disorders. However, the major drawback
here is that it cannot be used on a regular basis, and they
are not curative. Nitric oxide enhancers like sildenafil and
tadalafil facilitate vaginal lubrication. Estrogen‑containing
vaginal creams, phentolamine, prostaglandin E, L‑arginine
are also useful in female arousal disorders.[27]
Management of orgasmic disorders
Treatment commonly includes positive sexual attitudes
work, self‑pleasuring exercises, fantasy enhancement,
positive body image work, as well as Kegel (pelvic) muscle
exercises to facilitate easier orgasms. Masturbation by
self‑stimulation of genitalia or with a vibrator can provide a
woman with an opportunity to experience orgasm. Sensate
exercises to reduce anxiety are also useful.[28]
Treatment of dyspareunia
Dyspareunia has been a neglected area in sex therapy,
probably because of its not so frequent presentation in
clinical practice. Vaginal dilatation is the oldest and most
widely used treatment here. A method of the therapy called
physical therapy, which comprises Kegel exercise along
with other procedures like relaxation, postural education,
and biofeedback has also been found to be useful.[29]
Treatment of vaginismus
Cognition behavior therapy (CBT) has been found to be
most useful and successful in the treatment of vaginismus;
especially if it is of psychogenic origin. CBT strategies
mainly consist of:
• Information about the diagnosis of vaginismus including
the description of its anatomy, possible etiology, and
prognosis
• Sensate focus ‑ to reduce performance anxiety
• Vaginal dilation in a graded manner either with the
help of instruments or use of self‑finger approach for
desensitization
• Cognitive restructuring ‑ to change the dysfunctional
thoughts interfering with sexual functioning.[28]
CONCLUSION
Today we are into the 21st century. Yet when it comes to the
female sexuality, many cultures, and religions, especially in
the developing world impose social restrictions. This ongoing
restriction for ages has evolved a strong negativity among
women regarding sex. So even today the first healing step is
to create a factual awareness among them, as well as in the
entire society as to what is sexuality. This would probably
answer most of the problems related to female sexuality.
There are several sexual disorders specific to females based
on a sexual response cycle. The prevalence of these disorders
is not clear, mainly due to stigma associated with sex.
However, there are several therapeutic approaches that can
be utilized in effective management of these disorders.
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Source of Support: Nil, Conict of Interest: None declared
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... It acts as an integral component of the female identity which manifests as the perception of personal body image, gender identity, sexual orientation, fertility and femininity. Moreover, it serves as the core of a woman's personality and sexual self-concept which is expressed and experienced through behaviors, beliefs, values, fantasies and relationships [4,5]. Gynecological malignancies can be treated with surgeries, chemotherapy and radiation, either solely or in combination. ...
... As a consequence, these bodily responses might result in emotional deviations and provoke feelings of anxiety. Furthermore, the physiological responses related to the sexual response cycle including sexual desire, arousal and orgasm can be markedly affected [4,5]. Unfortunately, little attention has been paid to the resultant sexual complications that women experience. ...
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... Usually sexual activity in women begins during adolescence, reaches peak around the age of 30 years, and remains the same up to the age of 55 years. 16 TitOr/OL increases in those nearing menopause and in the postmenopausal age group. 17 Irrespective of the age, a positive selfebody image positively affects orgasm, indirectly affecting TitOr/OL positively. ...
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... Além disso, a melhora do fluxo sanguíneo pélvico, da mobilidade pélvica e da sensibilidade clitoriana após TMAP potencializaria não só a excitação, mas também a lubrificação vaginal e o orgasmo. 2,7,8 Assim, ambos, o TMAP e a conscientização da MAP, têm sido apontados como técnicas auxiliares no tratamento das disfunções sexuais femininas por alterarem de maneira positiva a vida sexual. O tratamento com esse foco frequentemente promoveria o aumento do desejo sexual com maior possibilidade de melhorar a excitação. ...
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With advancing age, there is an increase in the complaints of a lack of a libido in women and erectile dysfunction in men. The efficacy of phosphodiesterase type 5 inhibitors, together with their minimal side effects and ease of administration, revolutionized the treatment of erectile dysfunction. For women, testosterone administration is the principal treatment for hypoactive sexual desire disorder. We sought to evaluate the use of androgens in the treatment of a lack of libido in women, comparing two periods, i.e., before and after the advent of the phosphodiesterase type 5 inhibitors. We also analyzed the risks and benefits of androgen administration. We searched the Latin-American and Caribbean Health Sciences Literature, Cochrane Library, Excerpta Medica, Scientific Electronic Library Online, and Medline (PubMed) databases using the search terms disfunção sexual feminina/female sexual dysfunction, desejo sexual hipoativo/female hypoactive sexual desire disorder, testosterona/testosterone, terapia androgênica em mulheres/androgen therapy in women, and sexualidade/sexuality as well as combinations thereof. We selected articles written in English, Portuguese, or Spanish. After the advent of phosphodiesterase type 5 inhibitors, there was a significant increase in the number of studies aimed at evaluating the use of testosterone in women with hypoactive sexual desire disorder. However, the risks and benefits of testosterone administration have yet to be clarified.
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Background and aim: Sexual dysfunction adversely affects quality of life, self esteem and interpersonal relationships and it may often be responsible for psychopathological disturbances. The purpose of this study was to explore the prevalence and associated risk factors for Female Sexual Dysfunction (FSD) in women with Kurdish culture from western Iran . Material and methods: This was a cross-sectional descriptive survey which included 400 women aged 18-50 years old, married, from Ilam-IR, who were interviewed as per the Iranian version of Female Sexual Function Index (FSFI). The subjects were randomly selected from 4 primary health centres. Results: According to the findings, 185 (46.2%) women reported FSD. Prevalence of FSD increased with age, from 22% in women aged <20 years to 75.7% in women aged 40-50 years. FSD was detected as a desire problem in 45.3% of women, an arousal problem in 37.5%, a lubrication problem in 41.2%, an orgasm problem in 42.0%, a satisfaction problem in 44.5% and a pain problem in 42.5%. The educational level was inversely correlated with the risk of FSD (OR: 1.54 ,95% CI: 1.09-2.13). Patients with FSD were significantly more likely to be older than 40 years (OR: 2.23, 95% CI: 1.12-2.68), who had sexual intercourse fewer than 3 times a week (OR:1.85, 95% CI: 1.23-1.99), who had been married for 10 years or more (OR:1.76, 95% CI: 1.04-1.97), who had 3 children or more (OR: 1.48, 95% CI: 0.97-1.24), who had husbands aged 40 years or more (OR: 2.11, 95% CI: 1.35-2.37) and who were unemployed (OR: 1.34, 95% CI: 1.06-1.63). No significant differences were detected in smoking history, residences and contraception methods used (p>0.05). Conclusion: FSD needs to be recognized as a significant public health problem in Kurd women. Further research, particularly studies on awareness and competency of physicians in the management of FSD, is required.
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This article presents findings from a review of the evidence regarding sexual health for older women from MEDLINE, SCOPUS and the Cumulative Index to Nursing and Allied Health (CINHAL) databases. A total of 10 articles based on primary studies, reporting about the sexuality or sexual health of older women (and older people), and published between 2002–2012, were deemed suitable. The major themes that emerged from the available literature suggest that the sexual health of older people is affected by factors such as physical changes, mental health, changes to their relationship with their husband, chronic ill health and other psychosocial situations. It is concluded that nurses and other healthcare providers have a range of interventions that can be adopted to promote sexual health among older women. These interventions may focus on improving the older woman's sexual health assessment; increasing awareness and knowledge about sexuality in later life; pharmacological and psychotherapeutic therapies; using alternative techniques to achieve better sexual functioning; addressing partner and relationship issues, and advocating the importance of sexual health through media and policy development.
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Hypoactive sexual desire disorder (HSDD) is a prevalent and disabling condition for women and their partners. Clinical and empirical investigation into this disorder is still in developmental stages, and many questions about its etiology and treatment remain. Present understanding of HSDD leads to a holistic, biopsychosocial approach to this complex disorder. Emerging treatment views focus on multidisciplinary therapies that often integrate medical and psychosocial modalities.
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To evaluate sexuality in elderly couples and have the knowledge of its specific therapeutic options. Review of articles published on this subject in the Medline database, selected according to their scientific relevance together with a reflexion from our own experience. Due to increased life expectancy and the changes in society leading to a life with more than one consecutive partner, couples expect to continue sexual activity after the age of 65. Clinicians are asked to address this issue frequently. With age the frequency of genital sexual relations decreases. Sexual activity should be higher both for males and females. The quality of the relationship of the couple is a key element in maintaining sexual relations in this age group. Sexual satisfaction depends on the understanding, by both partners, of the physical and psychological changes due to increased age. The sexuality of the elderly couple must be analysed using specific criteria. The clinician's task is to explain to the patients the physiological change due to aging and give them advice on how to adapt their sexual behavior accordingly. Management will, at the same time, include pharmacological treatment, notably for erectile dysfunction, in order to restore satisfactory sexual relations. For women, vaginal lubrication products are essential. This global management should allow many elderly couples wishing to continue sexual relations, to enjoy this period of their lives in harmony with what they desire.