Women’s Sexual Health Overview

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Invited Expert AuthorsEvery now and then we’ll invite authors to write on this platform particularly when their expertise is a million times greater than mine. Female Sexual Health is one of those areas where my knowledge is limited. And yes, we have lots of female readers too at DrGeo.com. Enjoy!

Women’s Sexual Health Overview

By Robert Valenzuela, MD & Seth Cohen, MD

Women have more sexual health complaints than men, and women with sexual health problems have significant impairment of their life quality. Ironically, the study, diagnosis and treatment of women with sexual health concerns is limited.

“Sexual health” refers to a state of physical, emotional, mental and social well-being. Women have the right to a positive and respectful sexual relationship, and to have pleasurable and safe sexual experiences.

Following Masters and Johnson’s groundbreaking work in the early 1970s there was a flurry of scientific inquiry into the etiology and treatment of female sexual dysfunction. With the introduction of an oral treatment for erectile dysfunction, sildenafil (Viagra), a second renewed wave of scientific enthusiasm regarding female sexual dysfunction evolved. Now with the support from various medical and surgical societies like International Society for Sexual Medicine (ISSM) and the International Society for the Study of Women’s Sexual Health (ISSWSH), new treatment models are being studied and utilized in offices to treat female arousal problems.

Low Sexual Desire


Hypoactive sexual desire disorder (HSDD), refers to a persistent or recurring deficiency or absence of sexual fantasies or thoughts and desire for or receptivity to sexual activity that causes personal distress according to DSM-IV.

A woman’s sexual desire naturally fluctuates over the years. Highs and lows commonly coincide with menopausal status. Medications like antidepressants, anti-seizure medications and birth control all can cause low sex drive in women of any age.


Important to the treatment of any patient with HSDD is to start with a comprehensive history, followed by complete physical exam and lastly a full hormonal workup. By utilizing these three techniques the astute physician can come to a diagnosis and treatment approach quickly and efficiently.

Once the diagnosis has been made, hormone supplementation may be required to help achieve success; however, there are many non-hormonal techniques that can be utilized to correct low desire.

Sexual Arousal Disorders


Female sexual arousal disorder (FSAD) is a disorder characterized by a persistent or recurrent inability to attain sexual arousal or to maintain arousal until the completion of a sexual activity. The diagnosis can also refer to an inadequate lubrication-swelling response normally present during arousal and sexual activity.

This condition should be distinguished from a general loss of interest in sexual activity and from other sexual dysfunctions, such as the orgasmic disorder (anorgasmia) and hypoactive sexual desire disorder.


Female sexual arousal disorder is a complex problem with multiple overlapping etiologies. There are many treatment options with the optimal therapy depending on the etiology of the problem.

Available therapeutic options include adjusting medications, counseling, treating depression or anxiety, reducing stress and fatigue, sex therapy, devices and hormone supplementation therapy.

Painful Sex (Dyspareunia)

Biologic patho-physiologies resulting in woman’s sexual health problems associated with sexual pain may occur in the clitoris, urethra, bladder, vulva, vestibule, vagina, and pelvic floor muscles.

Clitoris, Prepuce:

In women with focused clitoral pain, clitoral itching, or clitoral burning, careful inspection of the glans clitoris should be performed. Failure to visualize the whole glans clitoris with the corona is consistent with some degree (mild, moderate, or severe) of prepucial phimosis, based on the elasticity of the prepuce and its ability to retract on examination. Since phimosis may create a closed compartment, phimosis is often the underlying pathology in clitoral glans balanitis associated with recurrent fungal infections.


Genital sexual pain in the vulva/vestibule may be related to varied specific disorders like hormonally mediated vestibulodynia, neuroproliferative vestibulodynia, and dermatologic conditions like lichen sclerosis and lichen planus.

Hormonally Mediated Vestibulodynia:

Hormonally mediated vestibulodynia symptoms are similar to those of neuroproliferative but seen more commonly in young women who have been exposed to birth control pills and menopausal women. Symptoms include vaginal dryness, painful sex (dyspareunia), itching and burning upon palpation of the vestibule.

Neuroproliferative Vestibulodynia:

Neuroproliferative vestibulodynia is a disorder seen less commonly than hormonally mediated vestibulodynia; it is seen in younger women who have either been living with vestibular pain since they “can remember” (congenital) or have developed symptoms over time. 

Hormone Imbalance and Female Sexual Dysfunction:

Androgens play an important role in healthy female sexual function, especially in stimulating sexual interest and in maintaining desire. Androgens are also vital for the health and maintenance of vaginal tissues including the vulva, vestibule and vagina.

There are a multitude of reasons why women can have low androgen levels with the most common reasons being age (pre- and post-menopause), oophorectomy and the use of oral contraceptives.

Symptoms of androgen insufficiency include absent or greatly diminished arousal, sexual motivation and/or desire, and persistent unexplainable fatigue or lack of energy, and a lack of sense of well-being.



APA Summary of Practice-Relevant Changes to the DSM-IV-TR.

Graham, Cynthia A. (2009). “The DSM Diagnostic Criteria for Female Sexual Arousal Disorder”. Archives of Sexual Behavior 39 (2): 240–55.

Bancroft, J. (2005). The endocrinology of sexual arousal. Journal of

Endocrinology, 186, 411–427.

Singer, B. (1984). Conceptualizing sexual arousal and attraction. Journal of Sex Research, 20, 230–240.

Laan, E., & Both, S. (2008). What makes women experience desire? Feminism & Psychology, 18, 505–514.

Arch Sex Behav. 2004 Dec;33(6):527-38.

Turning on and turning off: a focus group study of the factors that affect women’s sexual arousal.

Graham CA1, Sanders SA, Milhausen RR, McBride KR.

Bancroft, J. Central inhibition of sexual response in the male: A theoretical perspective. Neuroscience and biobehavioral reviews. (1999) 23, 763-784

Dennerstein, L., Burrows, G. D., Wood, C., & Hyman, G. (1980). Hormones and sexuality: Effect of estrogen and progestogen. Obstetrics and Gynecology, 56, 316–322.


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by Dr. Geo

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