Female Sexual Dysfunction (FSD)
A Simple Guide for Women
What is Female Sexual Dysfunction?
Female Sexual Dysfunction (FSD) is a term used to describe ongoing problems with sexual desire, sexual arousal, orgasm, or pain during sexual activity that cause significant distress, frustration, or relationship difficulties.
To be considered a sexual dysfunction, the problem should:
- Be present for at least 6 months
- Occur most of the time (more than 75% of sexual experiences)
- Cause significant personal distress or affect relationships
Sexual wellbeing is an important part of overall health and quality of life. When sexual problems are left untreated, they can contribute to low mood, anxiety, reduced self-esteem, and relationship difficulties.
How Common Is It? (Incidence/Prevalence)
Female sexual difficulties are common and occur more frequently in women than in men, although they are often under-reported because many women feel uncomfortable discussing them.
Sexual dysfunction is common throughout a woman’s life, including after menopause. The UK National Surveys of Sexual Attitudes and Lifestyles (NATSAL) demonstrated that many women remain sexually active well into later life, making sexual health important at every age.
Recent international studies suggest that approximately 40–50% of women may experience some form of sexual dysfunction during their lifetime.
Types of Female Sexual Dysfunction
There are three(3) main categories.
1. Desire and Arousal Disorders
These involve a reduced interest in sex or difficulty becoming sexually aroused.
Women may experience:
- Little or no interest in sexual activity
- Fewer sexual thoughts or fantasies
- Difficulty becoming excited during intimacy
- Reduced enjoyment of sexual activity
2. Orgasmic Disorders
This occurs when a woman finds it difficult or impossible to achieve orgasm despite adequate stimulation.
Problems may include:
- Delayed orgasm
- Absence of orgasm
- Less intense orgasms than previously experienced
3. Sexual Pain Disorders
Known medically as Genito-Pelvic Pain/Penetration Disorder.
Symptoms may include:
- Pain during penetration
- Burning or stinging sensations
- Deep pelvic pain during intercourse
- Fear of pain during sex
- Tightening of pelvic floor muscles making penetration difficult (called vaginismus)
Symptoms and Signs
Women with FSD may notice one or more of the following:
Desire-related symptoms
- Loss of interest in sex
- Reduced sexual thoughts or fantasies
- Avoiding intimacy
Arousal-related symptoms
- Difficulty becoming sexually excited
- Reduced vaginal lubrication
- Reduced physical response during intimacy
Orgasm-related symptoms
- Inability to reach orgasm
- Delayed orgasm
- Less satisfying orgasms
Pain-related symptoms
- Pain during intercourse
- Vaginal burning or soreness
- Pelvic pain during or after sex
- Anxiety related to sexual activity
Emotional effects
- Frustration
- Low self-confidence
- Relationship difficulties
- Anxiety or depression associated with sexual problems
What Causes Female Sexual Dysfunction?
FSD is often caused by a combination of physical, hormonal, emotional, and relationship factors rather than a single problem.
Physical Causes
- Endometriosis
- Pelvic organ prolapse
- Chronic pelvic pain
- Vulval skin conditions
- Urinary symptoms
- Neurological disorders
- Chronic medical illnesses
- Female Genital Mutilation
Hormonal Causes
- Menopause
- Reduced oestrogen levels
- Surgical removal of the ovaries
- Hormonal changes after childbirth or during breastfeeding
Psychological Causes
- Anxiety
- Depression
- Stress
- Negative body image
- Previous traumatic experiences
- Sexual abuse history
Relationship Factors
- Poor communication
- Relationship conflict
- Lack of emotional intimacy
- Partner sexual difficulties
Medication-Related Causes
Some medicines may affect sexual desire or sexual response, including certain antidepressants, sedatives, some anticonvulsants, and other long-term medications.
Treatment Options
Treatment depends on the underlying cause and often involves addressing several factors simultaneously.
Emphasises is on personalised approach.
Education and Information
Understanding how female sexual response works can be reassuring and may help women recognise that many sexual difficulties are common and treatable.
Counselling and Sex Therapy
Specialist counselling can help address:
- Anxiety
- Relationship concerns
- Previous trauma
- Sexual confidence issues
- Communication difficulties with partners
Treating Underlying Medical Conditions
Managing conditions such as:
- Endometriosis
- Pelvic organ prolapse
- Vulval disorders
- Menopausal symptoms
can significantly improve sexual function.
Hormonal Treatments: in the form of hormone replacement therapy(HRT)
For some women, particularly after menopause, hormone treatments may improve:
- Vaginal dryness
- Pain during intercourse
- Sexual comfort
- Sexual response
Vaginal Moisturisers and Lubricants
These can help reduce discomfort and improve sexual enjoyment, particularly when vaginal dryness is present.
Pelvic Floor Physiotherapy
Specialist pelvic floor therapy may help women experiencing:
- Painful intercourse
- Vaginismus
- Pelvic floor muscle overactivity
Lifestyle Measures
Helpful steps may include:
- Regular exercise
- Stress reduction
- Better sleep
- Stopping smoking
- Improving communication with a partner
- Managing long-term health conditions effectively
Key Message for Everyday Woman
Female sexual dysfunction is common, affects women of all ages, and is often treatable. Low desire, difficulty becoming aroused, problems reaching orgasm, or pain during sex are not simply things you have to “put up with”. Speaking openly with a healthcare professional can help identify the cause and lead to effective treatment options that improve both sexual wellbeing and overall quality of life.
Remember, ALWAYS consult with your GP and/or your gynecologist for your specific treatment options. Every woman is different!
References: Kershaw V, Jha S. Female Sexual Dysfunction. The Obstetrician & Gynaecologist. 2022;24:12–23. DOI: 10.1111/tog.12778.
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