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Female Sexual Dysfunction (FSD ) truly needs acknowledgement, identification & treatment

Female Sexual DysFunction, the FSD is a common occurrence observed in present gynaecological practice.

The incidence is seen to be rising surprisingly despite the society being more educated and permissive. In the long past, it was seen as a disorder linked with ageing and typically perimenopausal ( more than 40 Y of age ) women would be presenting. Rarely women would have sexual aversion due to fear instilled, either due to the family taboos or some experience of sexual assault. Rarely, still, it was associated with other physical or psychological disorders. Today increasingly we see a rising incidence and one which seems to be a common reason for infertility or inability to conceive.

This March 2019, #InternationalWomensMonth , I decided to put across the issue of FSD as it has been observed to adversely affect womanhood. Many women wouldn’t be able to understand the reason or have the courage to come to a doctor for guidance. This writeup is guidance in understanding the issue of FSD.

What is FSD or female sexual dysfunction ?

Female sexual dysfunction refers to a sexual problem associated with personal distress which may take several forms resulting in inability to perform and enjoy sex.

What are the various forms of FSD ?

Lack of sexual desire, inability to be aroused, inability to achieve an orgasm or pain at the time of sexual intercourse are the various forms of FSD

When does FSD start ?

Sexual dysfunction may be a problem since the start of sexual activity or may be acquired later in life after a period of normal sexual functioning

Whys is the FSD so prevalent today ?

This can be attributed to the female sexual response cycle which has undergone a paradigm shift in the context of today’s lifestyle. From the very basic carnal physical perception to some emotional underplay it has now turned to a response which has much more emotional expectations. Thus making it less of physical expression. Much of the response, therefore, gets influenced by couple relationship issues and other factors.

Is female sexual dysfunction due to pain ?

Pain happens to be an integral part of FSD. There may be fear of pain ( psychological ) or actual pain which is experienced by the woman. Fear of pain depends upon the information inputs received by the person through various sources or as a result of some anxiety. The pain experienced can also be due to underlying organic causes

What are the organic causes of sexual pain in women ?

Pain during sexual intercourse is called as Dyspareunia in medical terms. Dyspareunia can be a result of some organic issues such as Sexual Pain Disorders : dryness, infection or conditions such as endometriosis GUS of Menopause (VVA): Genitourinary Symptoms of menopause due to atrophy of the tissues of the genital region due to lack of oestrogen hormone Pelvic floor hyper tonus : the woman cannot relax her vagina and the surrounding structures; mostly are as a result of fear (Vaginismus: old term) Other forms of dyspareunia : some discomfort is associated with intercourse especially in the beginning and if this fear is carried throughout the sexual act becomes extremely uncomfortable.

Is sexual dysfunction emotional or psychological ?

Emotional and psychological distress is found to be associated with low sexual desire. Any association with aspects of mental or physical health also reduce sexual desire. This has been identified through a questionnaire of over 5000 women related to health and sexuality.

Do relationship issues affect the sexual desire ?

Yes relationship problems, constant fights, dissatisfaction and lack of communication can cause reduction in the sexual desire

How can one diagnose FSD ?

Diagnosis can be done for you by your doctor. The affected person first must realise that FSD exists.

There is a simple self-assessment checklist that one can take. 1. No interest or very little interest in sex 2. Reduced sexual arousal or feelings 3. Vaginal dryness 4. Inability to reach orgasm 5. Pain at the time of sex.

Can FSD be treated ?

Yes, it first needs to be understood by the person affected. One can seek a gynaecologists help and guidance and yes it can be treated.

As always I will share cases with you here to understand

Mrs X and Y were married for over 15 months and desired to have children. They were already evaluated by their local doctor and treatment in the form of pregnancy-related medications were already started. When they came to me I realised that they have not been able to consummate their marriage. A swift tutorial about sexuality and the sexual act followed. Fear of pain was identified as a major cause and was overcome by serial therapy and counselling sessions. The couple now have lovely two children delivered normally.

Mrs X and Y are married for 3 and a half years and came for consultation for infertility. She complained of sexual pain while he was scared of hurting her and therefore had developed a very low desire and sometimes erection failure . On evaluation, she had grade 2 endometriosis which was treated with medications and she conceived with ovulation induction and natural intercourse after counselling for sexual dysfunction.

FSD is an important part of femininity and female sexuality and it is important that women recognise it and seek treatment for the same. Wishing you all a very happy, satisfied and peaceful life.


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