Sexual problems

Woman probably had problems with sexuality since the beginning of time, but medical definition of female sexual disorders (FSD) was created only in last decades. Female sexual disorders are persisting or frequent annoyance in sexual life which is causing stress or dissatisfaction.

Female sexual disorders are complex phenomena which can have different and numerous causes. Same sexual problem can be caused by purely physical cause, more often by psychological cause or just bee reaction on partner behaviour or result of combined influence of many causes. Even ordinary lack of basic information about sexuality can lead to serious dysfunctions.

According to consensus classification in Statistical Manual of Disorders by American Psychiatric Association, Female sexual disorders follows linear model of the universal sexual response pattern.

1. Sexual desire disorders (hypoactive sexual desire, sexual aversion disorder)
2. Sexual arousal disorders
3. Orgasmic disorders (anorgasmia)
4. Sexual pain disorders (dyspareunia, vaganismus, other sexual pain disorders)

Challenging this concept of female sexual disorders which is based on universal sexual response pattern, equal for man and women and focused strictly on physiological function, The Working Group ‘New View of Women's Sexual Problems’ proposed new classification of Women Sexual Problems.

This corrective approach to Female sexual dysfunction emphasize relational, social and cultural context which are more often sources of women sexual complaints. Their approach gives priority to individual distress and inhibition considering differences in gender, social class, ethnicity, sexual orientation and widespread sexual violence. Because social environment can prevent the expression of biological capacities, such influence on women sexuality must be recognized.

1. SEXUAL PROBLEMS DUE TO SOCIO-CULTURAL, POLITICAL, OR ECONOMIC FACTORS

A. Ignorance and anxiety due to inadequate sex education, lack of access to health services, or other social constraints:

• Lack of vocabulary to describe subjective or physical experience.
• Lack of information about human sexual biology and life-stage changes.
• Lack of information about how gender roles influence men's and women's sexual expectations, beliefs, and behaviours.
• Inadequate access to information and services for contraception and abortion, STD prevention and treatment, sexual trauma, and domestic violence.

B. Sexual avoidance or distress due to perceived inability to meet cultural norms regarding correct or ideal sexuality, including:

• Anxiety or shame about one's body, sexual attractiveness, or sexual responses.
• Confusion or shame about one's sexual orientation or identity, or about sexual fantasies and desires.
• Inhibitions due to conflict between the sexual norms of one's subculture or culture of origin and those of the dominant culture.
• Lack of interest, fatigue, or lack of time due to family and work obligations.

2. SEXUAL PROBLEMS RELATING TO PARTNER AND RELATIONSHIP

• Inhibition, avoidance, or distress arising from betrayal, dislike, or fear of partner, partner's abuse or couple's unequal power, or arising from partner's negative patterns of communication.
• Discrepancies in desire for sexual activity or in preferences for various sexual activities.
• Ignorance or inhibition about communicating preferences or initiating, pacing, or shaping sexual activities.
• Loss of sexual interest and reciprocity as a result of conflicts over commonplace issues such as money, schedules, or relatives, or resulting from traumatic experiences, e.g., infertility or the death of a child.
• Inhibitions in arousal or spontaneity due to partner's health status or sexual problems.

3. SEXUAL PROBLEMS DUE TO PSYCHOLOGICAL FACTORS

A. Sexual aversion, mistrust, or inhibition of sexual pleasure due to:

• Past experiences of physical, sexual, or emotional abuse.
• General personality problems with attachment, rejection, co-operation, or entitlement.
• Depression or anxiety.

B. Sexual inhibition due to fear of sexual acts or of their possible consequences, e.g., pain during intercourse, pregnancy, sexually transmitted disease, loss of partner, loss of reputation.

4. SEXUAL PROBLEMS DUE TO MEDICAL FACTORS

Pain or lack of physical response during sexual activity despite a supportive and safe interpersonal situation, adequate sexual knowledge, and positive sexual attitudes. Such problems can arise from:

• Numerous local or systemic medical conditions affecting neurological, neurovascular, circulatory, endocrine or other systems of the body.
• Pregnancy, sexually transmitted diseases, or other sex-related conditions.
• Side effects of many drugs, medications, or medical treatments.
• Iatrogenic conditions.

Although safe and effective pharmacologic therapies for female sexual dysfunction have not been firmly established and there is still no single pharmaceutical drug for any of female sexual dysfunction, recommendations for treatment include cognitive-behavioural therapy aimed at changing maladaptive thoughts and unreasonable expectations, correcting misinformation about sexuality, and exploring strategies to improve couple emotional closeness and communication.