What are the Female Sexual Problems and Therapeutic Options

  Female Sexual Dysfunctions

Sexual satisfaction is an essential and natural part of life. It plays a key role to maintain quality of life of men and women. Sexual problems ultimately can reduce quality of life. Recent studies indicate that approximately up to 43% of women have disturbed from sexual difficulty during their lives. [1]Unfortunately, it is reported that 40% of women don’t discuss their sexual problems with doctors and clinician.[2]   Another study also suggests that 40% of women were affected by female sexual dysfunction (FSD).[3]

  What is Female Dysfunction?

WHO (World Health Organization) defined   FSD as ‘the various ways in which a woman is unable to participate in a sexual relationship as she would wish.[4] FSD is a multidimensional term which includes sexual disorders such as psychological, physiological, social and mental components.

Female sexual dysfunction (FSD) is more typical and complicated topic which considerably contained less importance and understandable in comparison to male dysfunction. However, Male sexual dysfunction has been broadly studied and its effective treatments are available in market.

Top 4 Female Sexual Problems (Sexual Disorder)

 Female sexual problems ( FSD ) include hypoactive sexual desire disorder (HSDD), arousal disorder, female orgasmic disorder and penetration disorder.

 Hypoactive Sexual Desire Disorder (HSDD)

Hypoactive Sexual Desire Disorder (HSDD) is the most common form of FSD (Female Sexual Dysfunction) and it can affect adult female of any age. It is defined as lack / recurrent absence of sexual fantasies/desire and thought to sexual activity.[5] It relates distress or interpersonal difficulties[6] but it does not exclusively attributed to another medical condition, pathology and physiological effects of a medication. [7] 

In addition, HSDD is a common condition that should be treated not only with cognitive behavioral therapy and psychological or psychosocial approaches but also pharmacological approach should be applied for  the treatment of HSSD.

Arousal Disorder (FSAD)

Arousal disorder is associated with female sexual interest. Arousal disorder can be defined as   an inability to attain or maintain sexual activity which include reduce of sexual desire, reduce in sexual fantasies, reduce of initiation of sexual activity with partner. [8] Sexual arousal includes a variety of outputs, including vaginal blood flow, clitoral, labial and vestibular bulb engorgement.[9]

Female Orgasmic Disorder

Female orgasmic disorder (FOD) is described as the recurrent difficulty in the occasions of sexual activity, delay in, or absence of, attaining orgasm following, reduces intensity of orgasmic sensations.  [10]

Genito-Pelvic Pain/Penetration Disorder

It is also called Sexual pain disorders. This disorder is described as persistent or recurrent difficulties with one (or more) of the following:

• Vaginal penetration during intercourse; or pelvic pain during vaginal intercourse or penetration attempts
•   Marked fear of or anxiety regarding vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration
•  Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.[11]

Therapeutic Options for Female Sexual Problems

 Female sexual dysfunction (FSD) is controlled by psychological, anatomical, biological and socio-cultural inputs. Multiple systems are involved in the treatment of sexual problems. It need a qualified and experienced physician who has specialized in sexual medicine and be able to using a variety of therapeutic approached including psychotherapy, hormonal therapy and behavioral approach.

• PDE5 Inhibitors

PDE5 inhibitor plays a significant role to increase blood delivery to the genitals. There are many PDE5 inhibitors available for the treatment of male erectile dysfunction and they effectively used for male sexual treatment.   However, clinical trial in women with FSD showed revealing sildenafil improved the ability to achieve orgasm and state of arousal.[12]

• Prostaglandins

Prostaglandins (PG) are found in almost all tissues and organs. They contribute to variety of psychological events including regulation of blood flow.  They have also positive effects on women with arterial smooth muscle relaxation, increasing vaginal secretion and genital sexual arousal disorder. [13]  Latest study recognized that, 400 female patients with FSAD showed improvement of sexual arousal rat when alprostadil was applied prior to vaginal intercourse.[14]

• Nitric Oxide Donor and Combination Therapy

It is well recognized that the production of NO donor is associated   with vascular relaxation. Pacher et al, established current application of a NO donor, DS1, a linear polyethylenimine-nitric oxide/nucleophile adduct, increased vaginal blood flow in anesthetized rats.[15] There are Some NO-donor creams are available in market and they have also get approval from FDA.   It is proved that some NO products such as  ArginMax® play a significant role to increase in clitoral sensitivity, sexual satisfaction, sexual desire, and decrease vaginal dryness.[16]

• Hormones

 Hormones play a Key role to drive sexual activities; Testosterone, estrogen and progesterone are strongly involved in the sexual response.[18] Latest studies suggest that there is strong association between neurotransmitters, and sex hormones (testosterone, estrogen, androgens).  These hormones play an important role in modulating sexual drives.

• Testosterone

Low levels of testosterone can negative effect on decreasing libido, genital orgasm and arousal system.  However, there are several concerns with testosterone replacement therapy in women; it may associate with long term side effects.

• Estrogen

Estrogen is a sexual hormone in female body and plays a fundamental role in the regulation of female sexual function. However, low level of estrogen can negative effect on sexual functions in women. There are many medications/therapy to maintain estrogen level. It is reported that Vagifem® (Pharmacia Upjohn) and Premarin® (Wyeth Pharmaceuticals) have positive effect to improve vavinal dryness and irritation.[19]  

It is important to keep in mind these female sexual problems not only relate to cognitive therapy, but it also relate to psychological, lifestyle, cultural and emotional aspects. Treatment should be focused on psychological and specific information regarding sexual desire, relationships and behavior. It is reported that lifestyle changes, motivations and behavioral change can positive effect on female sexual arousal and overall health condition.[20].

 There are many nontraditional medications/ products for sexual drives/ desire that have not been tested medically/clinically. Mostly they can negative impact on overall health and they also have very serious side effects. We must be avoiding from them.

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[1] Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999;281:537. [PubMed: 10022110]

[2] Berman L, Berman J, Felder S, et al. Seeking help for sexual function complaints: What gynecologists need to know about the female patient’s experience. Fertil Steril 2003;79(3):572-576. [http://dx.doi. org/10.1016/S0015-0282(02)04695-2]

[3] Kyan J. Allahdadi1,, Rita C.A. Tostes1,2, and R. Clinton Webb, Female Sexual Dysfunction: Therapeutic Options and Experimental Challenges, Cardiovasc Hematol Agents Med Chem. 2009 October ; 7(4): 260–269.

[4] NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993;270:83. [PubMed: 8510302]

[5] Basson R. Women’s sexual function and dysfunction: current uncertainties, future directions. Int J Impot Res 2008;20:466. [PubMed: 18548081]

[6] Rossella E Nappi, Ellis Martini,Erica Terreno, Francesca Albani,² Valentina Santamaria, Silvia Tonani, MD, Luca Chiovato, MD, and Franco Polatti, MD,^, Management of hypoactive sexual desire disorder in women: current and emerging therapies, Int J Womens Health. 2010; 2: 167–175. Published online 2010.

[7] Basson R, Berman J, Burnett A, et al. Report on the International Consensus Development Conference on female sexual dysfunction: definition and classification. J Urol. 2000;163(3):888–893. [PubMed]

[8] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision. Washington, DC: American Psychiatric Association, 2014.

[9] Giraldi A, Marson L, Nappi R, Pfaus J, Traish AM, Vardi Y, Goldstein I. Physiology of female sexual function: animal models. J Sex Med. 2004;1:237. [PubMed]

[10] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision. Washington, DC: American Psychiatric Association, 2014.

[11]  American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision. Washington, DC: American Psychiatric Association, 2014.

[12] Berman JR, Berman LA, Lin H, Flaherty E, Lahey N, Goldstein I, Cantey-Kiser J. Effect of sildenafil on subjective and physiologic parameters of the female sexual response in women with sexual arousal disorder. J Sex Marital Ther. 2001;27:411. [PubMed]    and

[13] Fourcroy JL. Female sexual dysfunction: potential for pharmacotherapy. Drugs 2003;63:1445.[PubMed: 12834363.

[14] Liao Q, Zhang M, Geng L, Wang X, Song X, Xia P, Lu T, Lu M, Liu V. Efficacy and safety of alprostadil cream for the treatment of female sexual arousal disorder: a double-blind, placebo-controlled study in chinese population. J Sex Med. 2008;5:1923. [PubMed]

[15] Pacher P, Mabley JG, Liaudet L, Evgenov OV, Southan GJ, Abdelkarim GE, Szabo C, Salzman AL. Topical administration of a novel nitric oxide donor, linear polyethylenimine-nitric oxide/nucleophile adduct (DS1), selectively increases vaginal blood flow in anesthetized rats. Int J Impot Res. 2003;15:461. [PubMed]

[16] Kyan J. Allahdadi1,, Rita C.A. Tostes1,2, and R. Clinton Webb, Female Sexual Dysfunction: Therapeutic Options and Experimental Challenges, Cardiovasc Hematol Agents Med Chem. 2009 October ; 7(4): 260–269.

[17] Giraldi A, Alm P, Werkstrom V, Myllymaki L, Wagner G, Andersson KE. Morphological and functional characterization of a rat vaginal smooth muscle sphincter. Int J Impot Res 2002;14:271. [PubMed: 12152117.

[18] Bancroft J. The endocrinology of sexual arousal. J Endocrinol 2005;186:411. [PubMed: 16135662]

[19] Labrie F, Cusan L, Gomez JL, Cote I, Berube R, Belanger P, Martel C, Labrie C. Effect of oneweek v treatment with vaginal estrogen preparations on serum estrogen levels in postmenopausal women. Menopause 2009;16:30. [PubMed: 18820592.

[20] Brotto L, Basson R, Luria M. A mindfulness-based group psychoeducational intervention targeting sexual arousal disorder in women. J Sex Med 2008;5:1646-1659. [http://dx.doi.org/10.1111/j.1743- 6109.2008.00850.x]