Is It All In The Head? - Understanding Psychosexual Disorders In Women, UK

Main Category: Sexual Health / STDs
Also Included In: Psychology / Psychiatry;  Women's Health / Gynecology
Article Date: 01 Nov 2007 - 2:00 PDT

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A new paper to be published in The Obstetrician & Gynaecologist ( TOG ) reviews existing scientific knowledge of women's sexual dysfunction and examines the different types of recognised psychosexual disorders to increase awareness of these issues amongst doctors.

Sexual dysfunction has been reported in 43% of women and most of these difficulties focus around areas such as desire, arousal, orgasm and sexual pain. A review carried out by the American Psychiatric Association in 1999 expanded these fields to include physical and psychological causes. The existence of non-coital pain disorder was also noted.

It is now widely accepted that responsive desire, triggered by mental and physical arousal, occurs in the majority of women, rather than spontaneous desire, which is less common. These problems are a result of a combination of biological, interpersonal, environmental and psychological factors that impact on a woman's reaction to sex.

The authors recognise that gynaecological conditions and procedures can be distressing for some women. Although overall sexual wellbeing improves after some forms of gynaecological treatment such as a hysterectomy, some women miss the sensations felt before surgery. Negative obstetric experiences such as birth trauma are also known to affect women's sexual response to stimuli. Other forms of treatment, whether drug-based or in the form of radiotherapy, have also been known to affect women's desire.

The common sexual disorders are:

- Sexual desire disorder - usually a result of personal experiences and cultural programming. Depression can have an effect and hormonal treatment is usually used.

- Sexual arousal disorder - a combination of physical and psychological factors. Pre-existing conditions such as diabetes or previous injuries may have an impact. Pharmacological treatment is used alongside physical treatment such as the use of lubricants.

- Orgasmic disorder - more common among younger women. Cognitive behavioural therapy, sexual education and Kegel exercises often used as treatment.

- Sexual pain disorder - (Dyspareunia) a physical condition that occurs when pain is experienced during penetration, usually a result of muscle tension in the vulva or pelvis. It is sometimes associated with dermatological conditions such as psoriasis and sometimes misdiagnosed as recurrent thrush. Vaginismus is also a physical condition but often a result of phobias caused typically by childhood sexual trauma or a background of severely oppressive religious orthodoxy. A combination of counselling and physical treatment such as the use of vaginal trainers has been known to help patients.

The authors recommend that doctors should be sympathetic to the sensitive nature of these sexual problems. They must have detailed notes of the woman's medical, pain, psychological and sexual history and need to have an understanding of the psychosexual function and the ability to communicate about these matters in a non-judgemental, non-intrusive manner.

Clinicians should also have some understanding of non-verbal communications in order to identify when women are feeling tense and anxious, and if they are displaying behaviours (such as complaining about pelvic pain, distress about having periods or disassociation during the time of genital examination) that reveal an underlying problem. A multidisciplinary approach is recommended and clinicians should have access to vulval pain clinics and a psychologist, therapist or psychosexual medical specialist, in order to provide good quality care.

Dr Catherine Coulson, from the Department of Reproductive Medicine at St Michael's Hospital in Bristol, who co-authored the paper said " Desire disorders become more common as women get older and are affected to an extent by hormones. Loss of desire may be experienced at the menopause regardless of age and is often reported after a surgically induced menopause.

"Similarly, a loss of desire may be a result of a previous experience of pain, guilt, shame, embarrassment or awkwardness. As a result, the woman may have learned to keep a tight rein on her emotions generally to avoid conflict or to suppress her anger.

"Some sexual problems need more time and expertise than is available in a general gynaecology clinic. However listening to the patient in an active way, understanding the exact nature of the problem and its impact on the woman and her relationship, if she has one, can in itself be therapeutic."

Professor Neil McClure, TOG editor-in-chief said, "There is much cross-over in the study of women's sexual dysfunction between medicine and psychology. As clinicians, we need to understand the complex layers of physical, psychological and social reasons why women sometimes have these difficulties if we are to provide women with the care they need.

"What is important is that gynaecologists have the appropriate training and skills to manage women presenting with psychosexual problems and that they are always vigilant in their identification."

The Obstetrician & Gynaecologist ( TOG ) is published quarterly and is the Royal College of Obstetricans and Gynaecologists' (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer reviewed journal aimed at providing health professions with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.

Reference

Coulson C, Crowley T. Current thoughts on psychosexual disorders in women. The Obstetrician & Gynaecologist 2007: 9 :217-222.

http://www.rcog.org.uk