Major Female Sexual Problem (Part 1)

Psychosexual Disorder

We recently discussed male major sexual problems and we got our box full of female related sexual issues. Most of it are what is termed ‘Psychosexual disorder’; various emotional cases inferring with sexual pleasure. We would share some of the cases in our subsequent posts. The treatment of most sexual problems lies in the underlying root issues. Therefore identifying the origin of the problem would help to solve it. In a recent study, about 43% of women report experiencing sexual difficulties. Despite the prevalence of these problems, they present only infrequently as such to clinicians. Often, they are presented indirectly along with other complaints such as pelvic pain, menstrual problems and dissatisfaction with contraception.

The underlying problems are easily overlooked as patients attend repeatedly at different services with unsatisfactory consultations. To appreciate this group of gynecological problems, it is important to be familiar with normal female sexual response. Traditionally, the sexual response cycle seen involves 4 phases: desire, arousal, orgasm and resolution. Though this marks out the physiological processes, it does not provide an adequate appreciation of the psychological overlay of the sexual response. It is also based on a traditional and heterosexual model where it is assumed that penetration and orgasm are the ultimate goals rather than self-satisfaction or bonding and intimacy.

Recent definitions acknowledge the importance of the sexual relationship, placing emotional and sexual satisfaction as equally important. There is an appreciation that the four phases are not a linear progression but are likely overlap.

The Diagnostic and statistical manual of mental disorders IV of the American Psychiatric Association (DMS-IV) classifies sexual dysfunction into four categories: sexual desire disorders, sexual arousal disorders, orgasmic disorders and sexual pain disorders.

Physiological factors, such as the menopause and depression, are known to affect sexual desire. However, sexual desire disorders are heavily influenced by psychological factors. Early negative experiences surrounding culture, loss and previous relationships can result in negative feelings that lead to avoidance of sexual intimacy. These emotions may include guilt, shame and embarrassment. Unrealistic expectations that sexual desire is a spontaneous response may create anticipatory anxiety surrounding intimacy. In some situations, underlying problems in the relationship are relevant (e.g. unequal power or infidelity)

Sexual arousal disorders can be an inability to achieve either physiological or subjective arousal. The physical changes of vaginal lubrication and pelvic congestion, associated with arousal, can occur without the ability to access the subjective experience of pleasure. Likewise, subjective arousal can be met with a lack of physical changes causing frustration. Mental disengagement and lack of awareness of the sensations of arousal can also contribute.

Reference

( gynaecology by Ten Teachers. Nineteenth edition)