Woman’s sexual dysfunction is the term for continual or constant decline in sexual desire, aversion to sex, problem being excited, wherewithal to reach orgasm, or dyspareunia which induces distress. A study of sexual behavior of American women and men, sexual dysfunction is a lot more frequent among women than males (Forty three vs . 31 %) . Sexual dysfunction can occur at any age in females, but “midlife” is usually a particularly common period for alterations to happen. The transition to menopausal impacts the lives of females in different ways. Many will notice little change, some may feel a marked improvement, while some will complain of declined sexual function.
These variations are understandable considering the multiple factors which can affect midlife sexuality: * Erratic ovarian functionality * Fluctuating, hormonal levels * Alterations in anatomical structure * Neurologic function * Vascular responsiveness * Psychosocial functionality * Relationship dynamics * Sexual philosophy * Expectations * Prior sexual encounters
Caring for women at this point of life presents a distinctive opportunity for the medical professional to inquire about the appropriate problems, bring the problem out into the open, and provide counsel and advice. This requires the cabability to communicate comfortably with patients plus an understanding of the physiology of human sexual response, the normal effects of maturing on sexuality, relationship dynamics, as well as medical provider’s personal boundaries.
PHYSIOLOGY OF THE USUAL HUMAN SEXUAL RESPONSE – Knowledge of the physiology of the typical sexual response can assist in knowledge of what exactly might go wrong.Your brain is the most important sex organ inside human body. Neurologic adjustments begin the process as the brain reacts for an image, thought, fantasy, smell, or other things that stimulates a response or invokes desire. This can lead to changes in vascular flow of blood. Sex hormones execute major roles here. There are actually estrogen, androgen, and progesterone receptors inside the brain. Estrogen and androgen receptors are notably dense within the hypothalamus, which controls sexual function and mood.
Estrogen increases blood circulation to the brain, could also increase vibratory sensation peripherally and have a positive effect on neuronal advancement and nerve transmission. Increased blood flow to the genitalia comes about along with sexual stimulation. This marks the arousal phase, where the additional blood flow produces peripheral reactions that define the sexual response. Estrogen boosts vaginal blood flow while a decreased concentration diminishes it. Addition of androgens to estrogen increases vaginal blood flow further. Blood flow can also be increased as a result of any mechanism that provides the neurovascular stimulus, whether it be sexual activity, use of sexual aids, masturbation, or fantasy.
Masters and Johnson – Masters and Johnson first detailed the phases of human being sexual response as a linear progression from excitement to plateau to orgasm, followed by resolution.
Excitement – Activation in the central nervous system (CNS) causes specific changes in blood flow. Ovarian hormones also play critical functions with this process, encouraging vasodilation and increased blood flow. Uterine and internal mammary arteries contain some of the highest density of estrogen receptors, that’s why their responsiveness in the excitement phase. Genital vasocongestion occurs as a result surge in blood flow as well as smooth muscle relaxation. The vaginal wall gets to be lubricated. The labia increase in dimension as well as spread open. The clitoris increases in proportions and the vagina expands while the uterus elevates. Other areas of the skin, including the face and breasts, demonstrate this rise in blood flow with the “sex flush.”
Plateau – Masters and Johnson introduced this as being a different phase. Actions associated with this phase include things like retraction of the clitoris and engorgement of the labia. Bartholin gland release takes place, in addition to congestion of the outer third of the vagina and further expansion of the upper 2 / 3 of the vagina. Muscle tension develops.
Orgasm – In the orgasm phase, 8 to 12 muscular contractions of the levator ani muscles take place at specific intervals. Vaginal and uterine contractions occur followed by massive release of muscle tension. Regularly orgasmic women will achieve orgasm 50 to 70 % of times and a satisfying prolonged plateau phase in other cases.
Resolution – The last phase, or culmination, can often be characterized as being a gradual, pleasant diminishment of sexual tension and response, differing in the time that it lasts among the individuals.
SEXUAL Variations WITH Growing old – Sexuality and sexual ability evolve over a lifetime of development and alter, depending on personal experience, interest, cultural attitudes, interpersonal relationships, desires, behaviors, physiology, as well as other factors.
Personal well-being – A woman’s sense of personal well-being is important to sexual interest and activity. Low perceived levels of physical and emotional satisfaction and a feeling of unhappiness correlate with decreased sexual interest, resistance to arousal, and pain during sexual intercourse. Women who experience premenopausal physical or emotional problems, in particular disorders of sexual interest, sexual response, and sexual behavior, usually experience a worsening these conditions after menopause.
Estrogen – Estrogen insufficiency develops gradually as females near menopause.
Urogenital function – Estrogen maintains the structure and functionality of the cells of the vagina. The bladder tissues also are afflicted by estrogen decline with mucosal changes that may lead to urinary frequency, urgency, nocturia, dysuria, and incontinence. Clitoral changes can take place, including a Fifty percent reduction in perfusion and shrinkage of the structure.Impact on sexual response – Alterations in the vaginal and clitoral tissues because of estrogen deficiency could have a profound impact on sexual response. The outer third of the vagina, including the labia and G-spot, exhibit reduced or absent congestion, as does the clitoris. Taken together, these changes may result in delayed arousal, delayed or absent orgasm, or diminished peak of orgasm. A fewer number of uterine contractions occur with orgasm
Androgens – All females generate some androgens, which can contribute to sustaining regular ovarian function, bone metabolic processes, cognition, and sexual behaviour, normal testosterone levels are crucial for arousal and orgasm to happen.
Diminished libido or sexual desire – Decreased libido or sexual interest, has increasingly become one of the more common complaints of women. Sexual desire includes sexual appetite, drive, and fantasy. While sexual arousal resulting in orgasm is predominantly a physiological event based upon neurovascular responses to stimuli within the proper hormonal milieu, sex drive or sexual desire is more psychosocial and behavioral, impacted by a variety of factors in day to day life and relationships. The desire for sexual intimacy can be reduced inspite of normal amounts of hormons.
Several factors influence sexual drive as well as expression. Lack of spontaneous desire is not a sexual dysfunction.Overall wellness and socioeconomic circumstances – Sexual dysfunction is highest in women with illness, low income, plus a history of limited sexual interest. Sexual dysfunction can be more prevalent amongst males and females with poor emotional and physical health.
Other – Several other predictors of decreased libido have been described in females in their late reproductive years, depressive disorder, vaginal dryness, and children residing at home had been connected to a greater risk of low libido.
Health problems – These problems can diminish the actual physical ability to perform sexually, such as with coronary heart or osteo-arthritis, or could affect arousal and orgasm capability as with neurologic disorders like multiple sclerosis, Parkinson disease, or diabetes mellitus. Alcohol and abusing drugs can have a debilitating affect on performance by altering erectile capability in the male and arousal in the female. Mental or emotional problems can impact sexual function due to particular disorder or to the therapy.
Medications – Either prescription and over-the-counter medications are capable to alter desire, arousal, and orgasm. One of the major classes that affects sexuality is (SSRIs), commonly used to treat depression. In many patients, treatments can reduce sexual desire and alter or eliminate arousal and orgasm.
Surgery – Surgical treatment related to malignancies of the breast or female genital tract may have a profound impact on sexuality in midlife, just like prostate surgery in men. This happens because of the extensive surgery impacting body image and function, plus the psychological sequelae of the cancer diagnosis and prognosis on patient and partner.
DIAGNOSIS OF SEXUAL DYSFUNCTION : need to start off with of a non-threatening question: – Are you sexually active? – Do you have any inquiries, difficulties, or issues concerning your sexual activity that you would probably like to discuss? – Does that trouble you or your partner? – Onset and duration and situational versus global effect. – Asking the patient of what she thinks is causing the problem. – Establishment of the patient’s sexual orientation is necessary for appropriate evaluation and management. – A thorough gynecologic examination is an critical component of the assessment. – Laboratory testing guided by the history as well as physical examination.
Basic Treatment Methods for Female Sexual Dysfunction Present education Provide information and education (e.g., about normal anatomy, sexual function, normal changes of aging, pregnancy, menopause). Provide pamphlets, encourage reading; discuss sexual issues when a medical problem is diagnosed, a different medication is started, and during pre- and postoperative periods; give permission for sexual experimentation. Enhance stimulation and eliminate routine Encourage using erotic materials (videos, books); suggest masturbation to increase familiarity with pleasurable sensations; motivate interaction during sexual activity; recommend using vibrators; discuss various positions, times of day or places; suggest setting up a “date” for sexual activity. Provide distraction techniques Encourage sexual or nonerotic fantasy; suggest pelvic muscle contraction and relaxation (a lot like Kegel exercise) exercises with intercourse; recommend usage of background music, videos or television. Encourage noncoital actions Recommend sensual massage, sensate-focus exercises (sensual massage without any involvement of sexual areas, where one partner provides the massage and the receiving partner provides feedback about what feels good; aimed to promote comfort and communication in between partners); oral or noncoital stimulation, with or without orgasm.
Minimize dyspareunia Superficial: female astride for control of penetration, topical lidocaine, cozy baths before intercourse, biofeedback. Vaginal: just like for superficial dyspareunia but with the addition of lubricants. Deep: position changes so that force is away from pain and deep thrusts are minimized, nonsteroidal anti-inflammatory drugs before intercourse.
Hormonal therapy: Like Estrogen and Testosterone.
ForEvaluation and Treatment of Female Sexual Dysfunction & all female pelvic issues Urinary Problems, prolapse, G spot augmentation,