What is Female Sexual Dysfunction?
Persistent, recurrent problems with sexual response, desire, orgasm or pain — that distress you or strain your relationship with your partner — are known medically as sexual dysfunction. Many women experience problems with sexual function at some point, and some have difficulties throughout their lives. Female sexual dysfunction can occur at any stage of life. It can occur only in certain or in all sexual situations. Sexual response involves a complex interplay of physiology, emotions, experiences, beliefs, lifestyle and relationships. Disruption of any component can affect sexual desire, arousal or satisfaction, and treatment often involves more than one approach.
Types of Female Sexual Dysfunctions [1]
Sexual dysfunction in women is a disorder that can take many forms and have many causes. It can occur before, during or even after sex. The most common problems related to sexual dysfunction include:
- Anorgasmia: Orgasmic disorder, or inability to have an orgasm.
- Dyspareunia: Pain during sex.
- Hypoactive sexual desire disorder: Low libido, or lack of sexual desire.
- Sexual arousal disorder: Difficulty becoming aroused despite desire for sex
Physical causes of sexual dysfunction in women may include:
Blood flow disorders: Some research points to vascular (blood vessel) disorders. These disorders may prevent blood flow to parts of the female reproductive system. The vagina, clitoris and labia need increased blood flow for sexual arousal.
Certain medications and treatments: Some medications affect sexual function. Antidepressants may reduce your sex drive or your ability to have an orgasm. Chemotherapy and other cancer treatments can also affect hormone levels and cause problems.
Gynecologic conditions: Endometriosis, ovarian cysts, uterine fibroids and vaginitis can all cause pain during sex. Vaginismus, a condition that causes vaginal muscle spasms, can also make intercourse uncomfortable.
Hormonal changes: Hormone imbalances may cause vaginal dryness or vaginal atrophy, making sex painful. Low estrogen levels can also reduce feeling in genitals. Menopause, surgery and pregnancy can affect hormone levels.
Particular health conditions: A number of health conditions can affect your ability to have a healthy sex life. These include diabetes, arthritis, multiple sclerosis and heart disease. Drug addiction or alcohol abuse may also prevent a healthy sexual experience.
Psychological causes of sexual dysfunction in women may include:
- Depression: Depression may cause a lack of interest in activities you enjoyed before, including sex. Low self-esteem and feelings of hopelessness can also contribute to sexual dysfunction.
- Stress: Stress at home or work can make it hard to focus on enjoying sex. Some studies show that stress can increase levels of the hormone cortisol. This increase may lower sex drive.
- Past physical or sexual abuse: Trauma or abuse may cause anxiety and a fear of intimacy. These feelings can make it difficult to have sex.
- Relationship issues: Some women may be unhappy with their partner or feel bored during sex. Other strains on the relationship may lead to sexual dysfunction. [2]
Markers of Metabolic Health
Metabolic health is defined as having ideal levels of blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and waist circumference, without using medications. These factors directly relate to a person’s risk for heart disease, diabetes, and stroke.
Some markers of metabolic health are triglyceride levels, blood pressure, LDL cholesterol levels, blood pressure and blood glucose levels.
Triglyceride levels: Blood triglyceride levels are crucial for the evaluation of fat metabolism. A level over 150 is regarded as metabolic disease.
Glucose control: Staying in your target range can also help improve your energy and mood. A fasting blood glucose of less than 100 mg/dL is considered ‘normal.’ Consuming low glycemic index foods are known to keep the blood sugar levels low or reduce the blood sugar levels. Glycemic Index (GI) measures how the body absorbs or digests foods, affecting the rate at which blood glucose levels rise.
Blood Pressure: A reading of 135/80 may suggest a risk for metabolic syndrome.
LDL levels: LDL cholesterol levels should ideally be less than 100 mg/dL. The range of 100 to 129 mg/dL is adequate for people with no health issues but may be of more concern for those with heart disease or heart disease risk factors.
These are some of the factors that influence metabolic health:
Sleep: Decreased sleep is a risk factor for increased blood sugar levels. Even partial sleep deprivation over one night increases insulin resistance, which can in turn increase blood sugar levels. The stress hormone, cortisol is increased by sleep deprivation and increases glucose. Insulin sensitivity is reduced by sleep deprivation and impacts glucose. The time of day a person sleeps impacts insulin and cortisol levels, both of which affect glucose. Increases in growth hormone accompany glucose increases during sleep. Oxidative stress and inflammation are increased by sleep deprivation and impact glucose.
Exercise: According to research that was published in BMJ, which took 36,000 individuals’ movements and measured their intensity of physical activity, data suggests that all physical activity, even low intensity counts. Low-intensity exercise such as brisk walking may have beneficial effects. Intense exercise is also known to improve metabolic health, but overexercising generally translates into prioritising performance over longevity. A regular exercise regime can improve metabolic health in a few weeks’ time. Research in mice and humans has suggested that intense exercise boosts communication between skeletal muscles and fat tissue. This helps in fine-tuning metabolism and improving performance.
Stress Reduction: Chronic stress can lead to dietary over-consumption (especially palatable foods), increased visceral adiposity and weight gain. Over time with chronic stress and chronically elevated glucose levels, the pancreas (which produces insulin to bring down glucose levels in the blood) loses the ability to respond to a high glucose stimulus, causing a reduction in the activity of insulin.
Nutrition: According to the World Health Organisation (WHO), consuming a healthy diet consistently can help prevent overall noncommunicable diseases (NCDs) and other conditions. Since there is an increased production and availability of processed, refined foods and change in lifestyle, people are consuming larger amounts of these high energy foods. This can possibly increase risks related to metabolic health.
FSD & Blood Glucose Levels
It’s crucial to first understand glucose metabolism to comprehend its connection with FSD. Insulin is a hormone created by the pancreas that controls the amount of glucose in a person’s bloodstream at any given moment. It helps store glucose in the liver, fat, and muscles, and regulates the body’s metabolism of carbohydrates, fats, and proteins. When blood sugar levels rise, insulin released by the pancreas helps the cells to absorb blood sugar for energy and storage. With this absorption, glucose levels in the bloodstream begin to decline. The pancreas then produces glucagon, a hormone that prompts the liver to release stored sugar. This interaction of glucagon and blood sugar ensures stable blood glucose levels in the body and the brain. The cells of individuals who have insulin resistance don’t respond well to insulin, barring glucose from entering them with ease. The glucose level in their blood rises over time even as their body produces more insulin as the cells resolutely resist insulin.
Obesity, high blood pressure, sleep apnea and depression are common conditions that occur alongside high blood glucose levels. Sleep apnea can put women at a higher risk for sexual difficulties. Depression and anxiety can also negatively impact the libido or lead to the use of medication that affects sexual interest or function. [9] High blood sugar can constrain blood flow to the genitals, required for heightened sensation and lubrication.
Fluctuating blood glucose levels can also impact hormones (progesterone and estrogen primarily responsible for sexual and reproductive development in women) which can affect libido. The (P4 receptor) progesterone receptor membrane component 1(PGRMC1) is known to stimulate pancreatic insulin secretion during gluconeogenesis. (Glucose is the fuel of the brain. Gluconeogenesis is the metabolic process of the formation of glucose from noncarbohydrate sources, whereas glycogenesis is the process of formation of glycogen from glucose). But P4 also increases hepatic glucose production via PGRMC1, which may exacerbate hyperglycemia (high blood sugar) in individuals with impaired insulin action.
Having high levels of glucose can damage nerves. The tip of the clitoris is loaded with nerves and if those nerves become damaged, the result might be decreased sexual sensation or even painful intercourse. When a woman is sexually stimulated, her brain transmits signals to her genitals to gear up for sex. Nerve damage from high blood sugar can interfere with the manner in which these signals are relayed. This may lead to loss of interest in sex and insufficient preparation of the body for sex.
Researchers theorize that inflammation may also dampen desire. Sexual desire is a brain-driven event, so if inflammatory molecules cross the blood-brain barrier and circulate in the area where there is sexual desire, then the desire for sex may be affected. [10]
FSD & Blood Pressure
The findings presented at the 21st Annual Scientific Meeting of the American Society of Hypertension (ASH 2006) in New York City, says that of 417 sexually active women aged 31 to 60, women with high blood pressure were twice as likely to experience sexual dysfunction compared with their counterparts who had normal blood pressure. What’s more, advancing age and duration of high blood pressure further increased the risk of sexual dysfunction in women. While high blood pressure can result in sexual dysfunction, some medications used to treat high blood pressure can also cause problems with sexual function.
In the study, women who took drugs to treat their high blood pressure, but did not reach their target goal were more likely to experience sexual dysfunction, compared with women who were not taking medication. However those women who had good control of their blood pressure through drugs were much less likely to experience sexual problems, the study showed. [11]
FSD & the Glutamate Metabolic Pathway
Glutamate is the most abundant natural nonessential amino acid in the central nervous system. Glutamate is an important neurotransmitter that plays a role in learning and memory. It serves as the major excitatory neurotransmitter in the brain, regulating neuronal excitability throughout the nervous system. Studies have shown glutamate to be important for sexual health and behaviour in females. The N-methyl-D-aspartate (NMDA) receptor is a glutamate receptor and ion channel in neurons that participates in female sexual behaviour. There, however, is a need to study these pathways better to get a clear understanding. There is increased interest in the scientific community to examine how glutamate release synchronizes with different phases of sexual motivation. The correlation studies show that metabolic health is important to avoid FSD. [12]
Research suggests that females could be at lower risk for the development of neurodevelopmental disorders than males due to enhanced neuroprotection, that female sex hormones offer. Estrogen is hypothesized to provide neuroprotection by suppressing the neuro-excitotoxicity induced by glutamate.
FSD & Metabolic Syndrome
Metabolic Syndrome (MS) was defined by a cluster of medical comorbidities, including central obesity, insulin resistance, impaired glucose metabolism, dyslipidemia (Abnormally elevated cholesterol or fats (lipids) in the blood) (hypertriglyceridemia, low high-density lipoprotein cholesterol) and hypertension. MS and its components are related to increased risk of several pathological conditions as diabetes mellitus, cardiovascular diseases, polycystic ovarian syndrome, obstructive sleep apnea, fatty liver disease, cancer, primary antiphospholipid syndrome and other rheumatic diseases as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis and fibromyalgia
Women with MS showed a higher prevalence of sexual inactivity and low sexual desire, orgasm and satisfaction compared to women without MS. Particularly metabolic components such as diabetes mellitus, dyslipidemia, systemic arterial hypertension and obesity were strongly associated with lower sexual desire, activity and Female Sexual Function Index total score in women. [13]
PCOS is a hormonal disorder that affects up to 26% of women globally every year. Polycystic ovary syndrome (PCOS) is a condition marked by the production of an abnormal amount of androgens, male sex hormones that are usually present in women in small amounts, by the ovaries. The name describes the multiple small cysts (fluid-filled sacs) that form in the ovaries.
The many symptoms of PCOS include excessive weight gain and excessive hair on the body due to an increase in androgens. These symptoms lead to a distorted body image, subsequently impacting sexual desire in women diagnosed with PCOS. Many patients with PCOS have features of metabolic syndrome such as obesity, hyperinsulinemia and insulin resistance. [14] A study is emphatic about the correlation between PCOS and FSD. It asserts that PCOS patients markedly suffer from sexual dysfunction.
Treatment/Prevention
Most types of sexual dysfunction can be addressed by treating the underlying physical or psychological problems. Other treatment strategies include:
Medication: When a medication is the cause of the dysfunction, a change in the medication may help. Men and women with hormone deficiencies may benefit from hormone shots, pills or creams. For women, hormonal options such as estrogen and testosterone can be used (although these medications are not approved for this purpose). In premenopausal women, there are two medications that are approved by the FDA to treat low desire, including flibanserin and bremelanotide. In case of an underlying condition, we recommend consultation with the relevant medical professional.
Mechanical aids: A vacuum device is also approved for use in women, but can be expensive. Dilators may help women who experience narrowing of the vagina. Devices like vibrators have been found to be helpful to improve sexual enjoyment and climax.
Sex therapy: Sex therapists can help people experiencing sexual problems that can’t be addressed by their primary clinician. Marital counselors can help address the underlying relationship issues.
Behavioral treatments: These involve various techniques, including insights into harmful behaviors in the relationship, or techniques such as self-stimulation for treatment of problems with arousal and/or orgasm.
Psychotherapy: Therapy with a trained counselor can help you address sexual trauma from the past, feelings of anxiety, fear, guilt and poor body image. All of these factors may affect sexual function.
Education and communication: Education about sex and sexual behaviors and responses may help you overcome anxieties about sexual function. Open dialogue with your partner about your needs and concerns also helps overcome many barriers to a healthy sex life. [15]
Studies have shown that addressing metabolic syndrome has helped fix female sexual dysfunction indirectly. According to sex therapist, Neha Bhatt, treatment for PCOS, one of the many conditions that have a reciprocal relationship with metabolic syndrome in women can involve a mix of weight maintenance, medication and psychotherapy which can further bring weight under control and hormones back in balance, enhancing a woman’s libido. The same also contributes to a better body and self-image which is an essential part of having a healthy sex life.
Conclusion
Persistent and recurrent distressing problems with sexual response, desire, orgasm or pain in women constitute female sexual dysfunction. It can take many forms and have many causes related to physiology, emotions, experiences, beliefs, lifestyle and relationships. Fluctuating blood glucose levels can damage nerves and also impact hormones that affect the libido. Women with high blood pressure are twice as likely to experience sexual dysfunction. Studies have shown that the glutamate metabolic pathway is important for sexual health and behaviour in females. Studies have also suggested that women with metabolic syndrome have a higher prevalence of sexual dysfunction. According to initial research, there seems to be a high correlation between PCOS and FSD.
Disclaimer: The contents of this article are for general information and educational purposes only. It neither provides any medical advice nor intends to substitute professional medical opinion on the treatment, diagnosis, prevention or alleviation of any disease, disorder or disability. Always consult with your doctor or qualified healthcare professional about your health condition and/or concerns and before undertaking a new health care regimen including making any dietary or lifestyle changes.
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