Medical information reviewed by Dr. Paige Kuhlman, a leading women’s urologist and Senior Medical Advisor at Hello Cake.
Researchers believe that up to half of women experience some degree of female sexual dysfunction, also known as FSD. (CSM, 2015). So… why have so few women heard of it? The answer, like FSD itself, can be complicated
Reason #1 is that FSD is not a single condition with a universal set of symptoms; it’s more of an umbrella term. In fact, nearly any recurring issue a woman might experience during sex – low sex drive, trouble getting wet, inability to orgasm – can fall under the umbrella of FSD.
And unsurprisingly, many women focus on their specific symptoms rather than the name of a category they happen to fall into. But that brings us to Reason #2 why you may not be familiar with FSD… women’s sexual satisfaction has been downplayed for so long that it can be hard to know what’s “normal”, let alone what treatments may be available.
That’s where this blog comes in. Keep reading to understand the signs of FSD, including surprising things you may not have known can be signs of female dysfunction.
1. When is low sex drive a sign of sexual dysfunction?
Most of us have trouble getting in the mood from time to time. Anything from poor sleep, to stress, to relationship challenges can tank our libido, so we may not think too much of it.
If you’re content with a “low” drive or if you identify as asexual, that’s A-OK. But if not, how do you know when low libido is worth talking to a doctor about? Here are a few possible indicators:
• Chronic Issues: A consistently low sex drive has been bothering you for several months or longer
• Drastic Change: If your libido drop came on rapidly, or if your sex drive is significantly lower than what you are used to
• Impact on Daily Life: If your sex drive is negatively affecting other aspects of your life, such as your mood, self-esteem, or relationship health. (To be clear: it’s never okay for a partner to shame or pressure you.)
• Medical or Psychological Causes: If you have, or suspect you may have, a medical or psychological condition linked with libido, including but not limited to:
– Hormonal imbalances from conditions like PCOS or hypothyroidism
– Energy and mood fluctuations from conditions like diabetes, heart disease, or chronic fatigue syndrome
– Mental or emotional impact from depression or anxiety
• New Medications: If you’re taking medications such as antidepressants that are known to interfere with libido, particularly if you were recently prescribed or your medication dosage was recently adjusted.
Depending on the cause of your low libido, treatments can vary from hormone replacement therapy, to injections, to less invasive treatments like oral medication.
2. Is pain during sex ever okay?
Short answer: no. There are a lot of reasons why sex might feel uncomfortable, but while all of them should be addressed, not all of them are considered signs of female sexual dysfunction.
Temporary issues like the ones below, for instance, are most likely not indicative of FSD:
• Vaginal infections such as yeast infection or bacterial vaginosis.
• Allergic reactions or irritation caused by latex condoms, spermicides, lubricants, or hygiene products.
• Not enough foreplay. “Enough” is relative, of course. In this case, let’s define it that you would typically be able to get aroused had foreplay lasted longer or felt more pleasurable to you.
• Acute vaginal dryness stemming from isolated instances such as dehydration or the use of antihistamines. Mild, occasional dryness can usually be remedied by a hydrating lubricant, while chronic or severe dryness may require medical treatment.
Now what if your pain is recurrent or persistent? In these cases, it may be considered a symptom of FSD. A few possible causes of chronic pain during sex include:
• Chronic vaginal dryness: Whether you regularly have trouble getting physically aroused or you’re experiencing hormonal changes like menopause or postpartum, chronic dryness is often classified as a sexual dysfunction.
• Trauma or Injury: childbirth, surgical procedures, or trauma to the pelvic region can cause scar tissue or changes in tissue elasticity.
• Pelvic Floor Disorders: Conditions such as pelvic floor muscle spasms (vaginismus), pelvic inflammatory disease (PID), or endometriosis can cause pelvic pain and discomfort during sex.
Whatever the cause, if you’re experiencing pain during sex, it’s recommended you talk to a doctor.
3. How often should I be having an orgasm?
One study found that 33% of heterosexual women reported having an orgasm *every* time they have sex. Another study estimates that 10-15% of women have never had an orgasm.
But there’s a lot between “always” and “never”, so the real question is: are you satisfied?
Like low libido, difficulty with orgasm is only diagnosed as a problem if it’s a problem for you. You’re not broken, but if you feel like something’s missing, your sexual satisfaction deserves attention and treatment.
How to achieve an orgasm – or why we can’t sometimes – is not an exact science, but there are several factors that are known to interfere:
• Psychological factors include stress, performance anxiety, body image issues, or past trauma can all cause a “mental block” that interferes with ability to reach orgasm.
• Relationship issues with your sexual partner can also interfere with ability to reach orgasm. Communication issues may discourage you from sharing feedback about what you need to reach orgasm. Conflict or lack of trust could be distracting you or preventing you from relaxing. Or loss of attraction could be getting in the way of desire or arousal.
• Medical conditions like diabetes, multiple sclerosis, neurological disorders
• Certain medications such as antidepressants (especially SSRIs), antipsychotics, and certain blood pressure medications, can delay or inhibit orgasm
• Aging: Hormonal changes during menopause, including declining estrogen levels, can lead to changes in sexual function and orgasmic response. Aging can also come with reduced blood flow and decreased sensitivity.
• Nerve function or trauma from surgical procedures such as hysterectomy or spinal cord injuries.
With so many possible causes, difficulty achieving orgasm may or may not require treatment, and if it does, that treatment can vary significantly. Some examples include:
• Psychotherapy, couples therapy, or sex therapy to identify and treat root mental or emotional causes
• Medication adjustments if anorgasmia is a side effect of a medication like an SSRI
• Topical creams or oral treatments containing pde5 inhibitors like Sildenafil or Tadalafil, if orgasm difficulties are linked to arousal, sensitivity, or bloodflow
• Hormone therapy, if anorgasmia is linked to hormonal imbalance or menopause
To recap: female sexual dysfunction, its causes, and its symptoms are complicated. There’s no “one-size-fits-all” approach to diagnosing or treating it, but there ARE diagnoses and treatments.
It starts with challenging the status quo and prioritizing your sexual satisfaction. If you’re struggling with low libido, discomfort, pleasure, or orgasm, talk to a doctor to find out if female sexual dysfunction treatment is right for you.
