Psychosexual and Relationship Therapy "Freedom-Enjoyment-Adaptability"

Female Sexual Problems

You may have seen increasing references to Female Sexual Dysfunction (FSD) over the last years –but what does it mean? FSD is an umbrella term that refers to the range of sexual difficulties experienced by women, and is often classified under

four broad headings:

A brief overview of the first three categories is given below. If you are experiencing pain during sex, or if the pain is preventing you from having sex, see “Overcoming Vaginismus” and “Vulval Problems and Painful Sex”. Of course, it should be recognised that the four categories of female sexual dysfunction – desire, arousal, orgasmic or pain disorders – do not exist in isolation from one another. If sex is not enjoyable because it is painful, frustrating or boring, then any desire to repeat the experience will diminish. Fortunately, the opposite is also true: good sexual experiences often lead us to want

more, which means that, with patience and effort, problematical patterns can be reversed.

1. Lack of sexual desire.

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2. Difficulties in becoming aroused

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3. Lack of ability to orgasm

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4. Dyspareunia/

Painful sex

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Another Perspective

Introduction

In 2000, concerned that women’s sexuality was becoming overmedicalised, a group of social scientists and clinicians got together to form a working group to produce what they believe is a more woman-centred definition of sexual problems. This gives priority to individual distress, but within a broader framework of cultural and relational factors.

Their view is that “all women are not the same, and their sexual needs, satisfactions and problems do not fit neatly into categories of desire, arousal, orgasm, or pain”. Here, then, is how they classify female sexual problems, which they define as “discontent or dissatisfaction with any emotional, physical, or relational aspect of sexual experience”.

I. 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:

1. Lack of vocabulary to describe subjective or physical experience.

2. Lack of information about human sexual biology and life-stage changes.

3. Lack of information about how gender roles influence men's and women's sexual expectations, beliefs, and behaviours.

4.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:

1. Anxiety or shame about one's body, sexual attractiveness, or sexual responses.

2. Confusion or shame about one's sexual orientation or identity, or about sexual fantasies and desires.

C. Inhibitions due to conflict between the sexual norms of one's subculture or culture of origin and those of the dominant culture.

D. Lack of interest, fatigue, or lack of time due to family and work obligations.

II. Sexual Problems Relating to Partner and Relationship

A.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.

B. Discrepancies in desire for sexual activity or in preferences for various sexual activities.

C. Ignorance or inhibition about communicating preferences or initiating, pacing, or shaping sexual activities.

D. 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.

E. Inhibitions in arousal or spontaneity due to partner's health status or sexual problems.

III. Sexual Problems Due To Psychological Factors

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

1. Past experiences of physical, sexual, or emotional abuse.

2. General personality problems with attachment, rejection, cooperation, or entitlement.

3. 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.

IV. 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:

A. Numerous local or systemic medical conditions affecting neurological, neurovascular, circulatory, endocrine or other systems of the body.

B. Pregnancy, sexually transmitted diseases, or other sex-related conditions.

C. Side effects of many drugs, medications, or medical treatments.

D. Iatrogenic conditions.

Some women and their partners might find this offers a more insightful way of thinking about women’s sexual issues.

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