Causes and Risk Factors of Female Sexual Dysfunction

Lacking sexual desire or being unable to enjoy sex is very common for females. Many factors in a woman's life can interfere with sexual function, and this often leads to a lower quality of life for her and her partner. Research suggests that nearly half of all women experience at least one symptom of sexual dysfunction at some points in their lives.

Sexual dysfunction refers to a problem during any part of sexual activity, from arousal to orgasm. Physical factors such as illnesses, surgeries, and hormonal changes related to menopause are often implicated in female sexual dysfunction, along with psychological factors like depression, anxiety, stress, and relationship difficulties. Here are some of the most common physical and psychological factors that may contribute to challenges enjoying sex. 

Physical Factors

Hysterectomy

Hysterectomy is the most common gynecological surgery, and about 20% of women report a decline in sexual function post-operatively.

Types of hysterectomy include:

• Total hysterectomy is removal of the entire uterus and cervix.
• Partial or subtotal hysterectomy is removal of the uterus while keeping the cervix in place.
• Radical hysterectomy is removal of the uterus and structures around it, such as the ovaries and lymph nodes (may be done to treat reproductive cancers).

There is a wide variation in sexual functioning post-hysterectomy. Some women notice that they do not experience contractions of the uterus they have previously associated with orgasm. Removal of the cervix may result in a change in the physical sensation experienced during deep penetration during intercourse. Removal of the uterus and ovaries causes a substantial decline in sex hormones.

Hormone replacement therapy—with or without testosterone replacement—may help to restore sexual function in women experiencing sexual difficulty after this surgery. Estrogen therapy in postmenopausal women who've had hysterectomies may improve vaginal blood flow, vaginal dryness, and inability to orgasm. Testosterone treatment may improve sexual desire and arousal.

Vaginismus

Vaginismus is a persistent or recurrent spasm of the outer third of the vagina. It causes vaginal intercourse to be painful or difficult, and it can also occur during pelvic exams. 

It can usually be treated by the use of vaginal dilators of increasing diameter, plus relaxation training.

The success rate increases in couples where the partner is involved in the therapy process. While treatment can help, it is important to note that some women have very intimate, loving relationships without intercourse.

Perimenopause and Menopause 

Hormonal shifts, including plummeting estrogen levels, usually begin before menopause. This often results in hot flashes, vaginal dryness, night sweats, mood swings, and decreased sensitivity to sexual touch. Testosterone drops with age for both men and women, which can also reduce a woman's sexual desire.

In postmenopausal or perimenopausal women, estrogen replacement can decrease symptoms of pain during intercourse and facilitate vaginal lubrication.

Studies have also shown that testosterone increases libido in women, so if your decreased desire is due to a drop in hormones, it may be improved with testosterone. However, to date, studies have used high doses of testosterone, which might lead to masculinization if taken for long periods of time.

Although DHEA is also a male hormone, there have been very few studies of its effect on women and none have shown that it improves a woman's libido.

If you are going through menopause, or you're in the years leading up to it and are noticing a change in sexual function, you might want to try increasing foreplay or sensual massage, which can boost the connection between you and your partner. You can also use lubricants or vaginal moisturizers and avoid sexual positions that cause pain or discomfort. 

Other Conditions

Other medical conditions like thyroid disorders, hypoadrenalism, hypopituitarism, nerve damage and nerve disorders, atrophic vaginitis, herpes, hyperprolactinemia, and general poor health can contribute to sexual dysfunction.

Further, some drugs and substances like alcohol, gonadotropin-releasing hormone agonists, anticonvulsants, beta-blockers and certain antidepressants (SSRIs in particular) have all been known to contribute to female sexual dysfunction. And nicotine may inhibit sexual arousal in women as well.

Psychological Factors

Depression and anxiety

Women with mental health conditions like depression and anxiety are more likely to experience sexual dysfunction. In a lot of cases, treating the underlying mental health condition helps alleviate sexual dysfunction.

Sexual dysfunction becomes less severe in up to 80% of women who have both major depression and sexual dysfunction when antidepressants effectively treat the depression.

Sexual Abuse in Childhood or Adolescence

Childhood sexual abuse has been identified as a risk factor for sexual dysfunction in women. Desire and arousal problems are the most frequently reported symptoms experienced by women with abuse in their pasts.

Additionally, people who have negative ideas about sex might be unable to maintain sexual function when desire or pleasure is not at its peak.

Relationship Concerns

Lack of trust in a relationship and/or a reduction in one's attraction to their sexual partner can cause or contribute to sexual dysfunction in women.

Other psychological factors like self-esteem and the fear of being vulnerable or letting go of control can cause sexual dysfunction.

Shifting one's focus to enhancing intimacy rather than having all interactions result in intercourse may help.

A Word From Verywell

Sexual response varies between people and can change for an individual. Sexual concerns are very common. Some sexual problems, while distressing, may reflect normal variations in a woman's life. It's important to keep in mind that a lack of sexual desire doesn't have to be a disorder. Not all sexual concerns or problems are dysfunctions.

Some people identify as asexual, and there is a spectrum of normal sexual interest. The main difference between sexual dysfunction and asexuality is that people with sexual dysfunction experience personal distress due to their lack of sexual interest, while people who are asexual do not.

Don't be afraid to talk to your healthcare provider and your partner. It can be difficult and uncomfortable to initiate a conversation with a medical professional about sex, but the majority of women can get effective help if they are willing to talk openly to their healthcare provider to determine the best treatment for their specific problem.