Sexual dysfunction in females can manifest itself in a range of ways. Females can experience pain during sex, a low libido, difficulty getting pleasure from sex, and difficulty having an orgasm.
A range of factors can contribute to these experiences, including physical illnesses, hormone changes, relationship problems, and social factors such as societal expectations around sex. Sometimes, they can affect a person’s mental health or their relationships.
However, not everyone views these symptoms as an issue. The amount it affects people can depend on the symptoms, their causes, and a person’s perspective on them.
Treating sexual dysfunction in females requires understanding the person’s treatment goals and needs and the likely underlying cause. Keep reading to learn more about the types of sexual dysfunction females can have.
Sexual dysfunction refers to a group of conditions that can prevent someone from having, or enjoying, sex. These conditions can affect every stage of sex, from a person’s desire to their ability to orgasm.
Sexual dysfunction is very common in all people, including females. A 2018 study estimates a worldwide prevalence of 41% among females of reproductive age.
In females, sexual dysfunction can cause difficulty with:
- Desire: A low libido can be a form of sexual dysfunction if it causes someone distress. People who identify as asexual or demisexual do not fall into this category as these are sexual orientations rather than medical conditions.
- Arousal: This is when a person wants to have sex, but their body and mind have difficulty preparing for it. For example, the vagina may not lubricate itself or swell the way it should.
- Pain: Some conditions cause pain in or around the genitals, making it difficult to have sex. This pain may occur only during sex or at other times too.
- Orgasm: A person might be able to have sex but have trouble reaching orgasm even when they are enjoying it.
The clinical definition of female sexual dysfunction, and the disorders that fall under this umbrella term, have shifted over time. As experts gain greater understanding of female desire and arousal, it may continue to evolve.
Physical, psychological, and social factors can all contribute to any type of sexual dysfunction in females. The level of dysfunction may be mild or severe, short term or long term.
Some types of sexual dysfunction are primary, or always present, while others are secondary and develop later in life due to other circumstances. For example, a medication or illness might cause secondary sexual dysfunction.
Depending on the case, sexual dysfunction may have only one cause or multiple contributing factors. A 2018 systematic review of 135 prior studies from various cultures found that certain factors correlate with a higher risk of sexual dysfunction, including:
- Education: In the review, a lower level of education was frequently linked with higher risk of female sexual dysfunction. This included general education as well as sex education.
- Relationship problems: Sources of relationship dissatisfaction, such as a partner being unfaithful or lacking affection, elevate the risk of sexual dysfunction.
- Male-centric sexual interaction: A focus on male pleasure can mean that while people understand what makes sex enjoyable for males, many people lack knowledge on what makes it enjoyable for females.
- Health conditions: General low physical health and conditions that affect the genitals and urinary tract are potential causes of sexual dysfunction. Stress and mental health are also important.
- Marriage practices: Child marriage, arranged marriage, and polygamy are associated with higher risk of female sexual dysfunction.
- Religion: In the review, scientists found that being religious was correlated with higher levels of dysfunction.
- Abuse: This includes domestic abuse, sexual assault, and female genital mutilation (FGM).
- Gender inequity: This global issue makes it more difficult for women to access sexual health services, especially if they are unmarried and live in a country where sex outside of marriage is socially unacceptable. It also drives many other risk factors for sexual dysfunction, including abuse and FGM.
Many things can affect a person’s level of desire and arousal. To an extent, it is typical for this to fluctuate throughout life. Some people may naturally feel less interest in sex than others.
However, if a person experiences new changes to their levels of desire or arousal, it may signal a specific condition.
Female sexual interest/arousal disorder (FSIAD)
FSIAD is a diagnosis that includes both difficulties with sexual desire and physical arousal. To qualify for a diagnosis, a person must have significantly reduced desire, arousal, or both for
A person with FSIAD may have no or very little interest in sex, as well as decreased pleasure when they do have sex. However, it is only FSIAD if the person experiences distress because of these symptoms, and there is no other cause that could better explain them, such as:
- domestic abuse
- a mental health condition
- medication side effects
Persistent genital arousal disorder
Persistent genital arousal disorder causes unexplained physical genital arousal, whether or not a person experiences desire or wants to feel arousal. A person may involuntarily orgasm.
For years, doctors treated this as a psychological problem. However, newer evidence suggests that neurological issues, such as nerve damage and brain lesions, may cause this condition.
- Vaginismus: This causes the muscles of the vagina and pelvic floor to involuntarily contract prior to penetration. This can make sex painful or impossible. Pelvic floor damage can cause it, but it often has a psychological cause, such as anxiety or shame around sex, or past sexual trauma.
- Infections: Sexually transmitted infections (STIs) and yeast infections can cause pain during sex, as well as outside of sex.
- Skin diseases: Conditions that affect the tissue of the vulva, vagina, and surrounding areas can make sexual contact painful. Some examples include psoriasis and contact dermatitis.
- Endometriosis: This causes tissue of the uterus to grow outside of the uterus. Endometrial adhesions can damage the pelvic floor and cause pain during sex.
- Low estrogen: Low levels of this hormone may make it difficult to get sufficiently lubricated for sex. It can also cause the vaginal tissue to thin, making sex painful. Low estrogen can occur for many reasons, such as menopause and recent childbirth.
- Pelvic organ prolapse: This happens when weakness in the pelvic floor causes the pelvic organs, such as the bladder and uterus, to drop down into the vagina. It does not always cause symptoms but can also cause sexual pain.
- Pelvic floor dysfunction: Other issues with the pelvic floor, such as injured or tight muscles, can make sex painful. Pelvic floor dysfunction can happen for many reasons, including following surgery or an injury, during pregnancy, or after childbirth.
Difficulty reaching orgasm is not necessarily the result of a health condition. Some people naturally need more stimulation than others to have an orgasm. A person may need to experiment and find what works best for their body, or teach their partner.
However, this is sometimes the result of female orgasmic disorder (FOD). FOD is when a person does not have orgasms during sex or when orgasms dramatically diminish in intensity or frequency, despite a person getting sufficient stimulation.
The condition has two subtypes. Primary FOD means a person has never had an orgasm. Secondary FOD means a person was once able to orgasm but now has difficulty.
As with the other forms of female sexual dysfunction, many factors can contribute to it, including hormone changes, relationship issues, and underlying diseases.
Because sexual dysfunction is so varied, a doctor may run a few tests to determine the cause of the symptoms and make a diagnosis.
This will begin with some questions about someone’s symptoms, when they began, and whether anything makes them better or worse. A doctor may need to ask personal questions, such as how often a person has sex, and any adjustments they have tried to help with their current symptoms.
Next, they may recommend diagnostic tests. This may include:
- a pelvic exam
- STI testing
- medical imaging
- hormone testing
- a mental health assessment
The treatment for female sexual dysfunction depends on the cause, or causes, of the symptoms.
A doctor or sexual health expert may begin by identifying any obvious potential causes, such as previous or current experiences of abuse, sexual trauma, or FGM. If these could be playing a role, they may refer someone for treatment that specifically addresses the mental and physical impact of these experiences.
If these are not factors, treatment may involve:
- Sex education: Sometimes, people can have mistaken beliefs about sex that prevent them from fully enjoying it. For example, people may believe that the aim of all sexual activity is orgasm or that most females should be able to orgasm through vaginal penetration alone. Clearing up any myths or misunderstandings, and learning sexual techniques, may help significantly.
- Relationship counseling: If an unresolved relationship problem could be affecting a person’s trust, desire, or attraction to their partner, then visiting a counselor may help. Counselors can act as mediators, allowing couples to have productive conversations and resolve issues.
- Mental health treatment: A therapist can help someone cope with and reduce stress, anxiety, depression, low self-esteem, post-traumatic stress disorder, and internalized shame or guilt surrounding sex.
- Hormone therapy: For those with low estrogen, topical estrogen or oral hormone replacement therapy may help with desire or arousal problems, such as a lack of lubrication.
- Dilator training: People with vaginismus can try dilator training, which involves inserting a smooth plastic dilator into the vagina while trying to relax the pelvic floor muscles. Once a person feels comfortable with one size, they move up a size until they can have sex without pain.
- Pelvic floor exercises: Other types of pelvic floor exercise, such as Kegels, aim to strengthen the pelvic floor due to injury or weakness.
- Other medications: Drugs such as flibanserin (Addyi) and bremelanotide (Vyleesi), which some call “female Viagra”, aim to increase sexual desire. Changing or stopping a medication someone is already taking that may be affecting their sexual function is another option. People should only do this with the approval and supervision of a doctor.
- Surgery: In some cases, surgery may be necessary to correct structural problems around the vulva or inside the vagina. This may include complications from childbirth, FGM, or organ prolapse. Sometimes, a person may need surgery for a structural difference present from birth.
People cannot always prevent sexual dysfunction, but there may be ways to reduce its likelihood.
The 2018 systematic review identified protective factors for female sexual dysfunction. The factors that people may be able to work on, either by themselves or with a partner, include:
- getting adequate sex education
- communicating clearly and effectively about sex
- showing daily affection in relationships
- using contraception
- having a positive body image
Some causes of sexual dysfunction are permanent. For example, a person with nerve damage may not recover feeling or function around the vulva.
However, support and treatment is available for many other causes of sexual dysfunction in females. Even severe injuries, such as tears or significant pelvic floor prolapse, have many treatment options.
People can speak confidentially with a doctor or gynecologist about the symptoms they are experiencing. Some may prefer to speak with a female doctor or get recommendations for understanding doctors from friends or family.
If a doctor does not listen or take the symptoms seriously, people should seek a second opinion.
Sexual dysfunction is complex and can have a range of contributing factors. In females, it may cause problems with desire, arousal, orgasm, or pain during sex.
Sometimes, there is a single, treatable cause for sexual dysfunction in females. In other cases, a person may need to speak with several medical professionals to address physical, psychological, or social factors that are contributing.
With the right support and treatment, many people can notice improvements in their sexual experiences and intimate relationships.