Overview of Female Sexual Dysfunction
Concepts of female sexual dysfunction are controversial, particularly those based on biological causes. The American Psychological Association (APA) classifies female sexual problems as mental disorders: loss of sexual desire or arousal, discomfort during intercourse, diminished blood flow to the vagina, trauma-related aversion to sex, and the inability to achieve orgasm. Historically, psychiatrists and sex therapists have diagnosed and treated these disorders, perhaps, in many cases, according to limited perspectives maintained by psychiatric literature. Urologists and gynecologists now treat female sexual problems that result from medical conditions causing diminished pelvic and vaginal blood flow and nerve damage.
Currently, urologists, behavioral scientists, and psychologists are looking at medical, cultural, psychological, and relational reasons for women's sexual dysfunction, perhaps more accurately termed sexual dissatisfaction. They are emphasizing education and communication between partners. Surveys of women suggest that therapy should focus on women's physiological needs to experience enjoyable sex instead of medical conditions. Under this view, sexual dissatisfaction is symptomatic of an intimacy problem in which one or both partners fail to communicate their needs.
A useful model for exploring disturbances in female sexual response considers traditional and innovative, psychiatric and medical, and psychological and physiological perspectives. For some women, dysfunction or dissatisfaction is defined by a loss of interest in sex (low libido) and the inability to become aroused or to achieve orgasm when participating in sex. Many are dissatisfied because their partners are uneducated or inattentive and do not understand female arousal and its anatomical basis. For others, a medical evaluation uncovers a physiological problem that impairs sensitivity. The concept of female sexual dysfunction, or dissatisfaction, remains poorly defined.
Incidence and Prevalence
The absence of dependable empirical data combined with varying definitions about sexual dysfunction, and even normal sexual practices, prevents a clear understanding of the prevalence of women's sexual problems. While some studies document a prevalence of sexual dysfunction among non-Caucasian women and women of lower socioeconomic status, opponents of these studies point to a lack of diversity in these test populations.
A survey conducted by the American Medical Association in 1999 indicates that sexual dysfunction affects approximately 43% of women in the United States. Age may not be a significant factor, as women under 20 and over 50 experience problems with arousal, orgasm, and satisfaction. However, there is evidence that the majority of female sexual dysfunction happens after menopause, when hormone production drops and vascular conditions are more common.
The clinical definition of the female sexual response cycle consists of four stages of arousal, marked by physiological and psychological changes. The first stage is excitement, which can be triggered by psychological or physical stimulation, and is marked by emotional changes, and increased heart rate, respiration, and vaginal swelling and lubrication due to increased blood flow. Sustained excitement is called the plateau, the second stage. Vaginal swelling, heart rate, and muscle tension may increase as long as stimulation continues. The breasts enlarge, the nipples become erect, and the uterus dips. The third stage is orgasm, which involves synchronized vaginal, anal, and abdominal muscle contractions, the loss of involuntary muscle control, and intense pleasure. The final phase, resolution, involves a rush of blood away from the vagina, shrinking breasts and nipples, and a reduction in heart rate, respiration, and blood pressure.
A normal or healthy response cycle may be as poorly defined as a dysfunctional one. How women experience these stages varies; for example, some progress from excitement to orgasm rapidly, and others alternate between plateau and orgasm several times before reaching resolution.