Introduction to Sexual Dysfunction in Women
Women’s sexual health has historically been poorly understood and only recently been studied extensively enough to give us information on how to help women lead sexually gratifying lives. The current management of female sexual dysfunction involves biological, psychological, and relationship oriented evaluations for adequate treatment.
The Kegel muscles tone, strength, and health are important for acceptance of penetration, responsiveness, proper function and pleasure as well as for orgasmic contractions. Pelvic floor disorders can decrease arousal and even affect sexual satisfaction. This is especially true when painful intercourse is occurring.
Hyperactive contractions of the pelvic floor are commonly found with dyspareunia (painful deep insertion) and vaginismus (pain with attempt or superficial entry). The pelvic floor is key to understanding how events such as vaginal delivery may effect the health of the Kegel muscles for life. Surgical procedures, such as episiotomies or pelvic organ prolapse repairs, may also affect the health of the muscles causing life long pain and discomfort with sexual intimacy.
Women’s Sexuality is a Complicated Process
The woman’s sexual cycle is controlled by biology, psychosexuality, and romantic relationships with partners. It requires a healthy nervous system, hormonal balance, muscular strength, and good pelvic floor health.
Female sexual dysfunction is related to age, increasing in frequency with age. One in three reproductive age women will report problems with sexual relations, while half of women in the menopause will complain of it. There may also be a spectrum from dissatisfaction to dysfunction, which means that early treatment may help prevent the progression. Health pelvic floor muscle function is the most important cause, but is often the most overlooked. Women that report history of recurrent bladder infections have been shown to report more problems with arousal and complain of more pain with intercourse.
Categories of Female Sexual Dysfunction
There are many causes of problems with intercourse and a thorough evaluation with history and physical by your physician will be the starting point. There are specialists who only focus on the female sexual dysfunction, who are available for help.
- Women’s Sexual Interest/Desire Disorder: decreased or absent feelings of sexual interest including absent sexual thought or fantasies. No motivation to become sexually aroused.
- Sexual Aversion Disorder: extreme anxiety or disgust at the thought or request for sexual intimacy
- Subjective Sexual Arousal Disorder: no pleasure with intercourse even though vaginal lubrication and other physical signs occurring.
- Genital Sexual Arousal Disorder: No sexual arousal including lack of vaginal swelling and lack of lubrication with stimulation. May even report decreased sensation felt with touching of clitoris and vagina.
- Persistent Sexual Arousal Disorder: signs of arousal such as throbbing, pulsating, and tingling in the absence of sexual desire. Orgasms do not relieve the feelings of arousal and the feelings may persist for hours.
- Women’s Orgasmic Disorder: In spite of being highly aroused and excited, there is a lack of orgasm or marked delay from prolonged stimulation.
- Dyspareunia: Persistent or recurrent pain with vaginal penetration and intercourse.
- Vaginismus: Difficulty of the woman to allow penetration of penis, finger, or object despised desire to do so. The pain results in a fear of attempting intercourse and prolonged muscle contractions may be reported. No anatomical problems seen.
How can Pelvic Floor Therapy Help Female Sexual Dysfunction?
Low desire may be associated with vaginismus or dyspareunia. In both conditions, defensive contractions may be the cause. Using electrical stimulation to fatigue the muscles will lead to relaxation of the spasm.
Genital arousal disorders may be caused by overactive Kegel contractions causing pain. The pain results in lack of vaginal swelling and lubrication. Pelvic floor rehabilitation will result in relaxing the overactive contractions, thereby decreasing pain.
This is where pelvic floor rehabilitation is most successful. Weak Kegel muscles are associated with weak or absent orgasms. Fear of loss of urine during intercourse is also a cause of lack of orgasm. Pelvic floor therapy will increase the strength of the Kegel muscles which will lead to improved bladder control (eliminating the fear of leakage) and result in stronger contractions during orgasm, which result in stronger orgasms.
If you suffer from any of the above female sexual dysfunction categories, ask your doctor for a referral or contact the Better Bladder Center to see if you are a candidate for pelvic floor rehabilitation including electrical stimulation.