Female sexual dysfunction (FSD) includes a range of conditions that can affect a woman’s sexual health and well-being. These issues are common and often treatable. Understanding the different types of FSD can help women recognize symptoms, seek help, and explore treatments that work for them. Here is an overview of the main types of FSD, along with possible treatment options.

Hypoactive Sexual Desire Disorder (HSDD)

Hypoactive sexual desire disorder (HSDD) is a persistent or recurrent lack of sexual desire, which may include a reduced interest in initiating or engaging in sexual activity. Women with HSDD may also find it difficult to respond to sexual cues or fantasies, and these feelings often lead to personal distress, such as frustration, sadness, or worry.

Treatment Options: HSDD treatment may include education on normal sexual functioning, therapy (e.g., cognitive-behavioral therapy), or medications that help improve sexual desire. Some women find benefit in hormone-based treatments, especially postmenopausal women. Counseling and partner involvement can also play an important role.

Female Sexual Arousal Disorder (FSAD)

Female sexual arousal disorder (FSAD) involves difficulty with arousal, which may include a lack of mental excitement or physical response (such as lubrication or genital sensitivity) during sexual activity. FSAD can be separated into cognitive (mental) arousal issues and genital (physical) arousal issues, each of which can affect the experience of intimacy.

Treatment Options: Treatment may focus on addressing underlying factors such as stress, mood issues, or relationship quality. Non-drug approaches include mindfulness techniques, pelvic floor physical therapy, and the use of stimulation devices. Therapy options can include individual or couples counseling to address emotional factors or increase comfort with intimacy.

Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

Persistent genital arousal disorder (PGAD) is characterized by unwanted and ongoing feelings of genital arousal, such as tingling, swelling, or contractions. These sensations occur without sexual desire or stimulation and can be distressing or disruptive to daily life.

Treatment Options: PGAD management often focuses on reducing symptoms and managing discomfort. Treatments may include physical therapy, counseling, or techniques to manage stress and anxiety. Some patients benefit from medications that help reduce genital sensitivity or treat underlying nerve-related issues.

Female Orgasmic Disorder (FOD)

Female orgasmic disorder (FOD) refers to difficulties with achieving orgasm or experiencing intense orgasmic sensations. This condition can be either lifelong (never having had an orgasm) or acquired later, and it may occur in all situations or only in certain ones.

Treatment Options: Therapy, including cognitive-behavioral therapy, can help address FOD by focusing on reducing anxiety, building communication skills, and exploring techniques like directed masturbation. Educational resources on anatomy and masturbation may also help women feel more comfortable with their sexual responses.

Sexual Pain Disorders

Sexual pain disorders can make intimacy uncomfortable or painful. Vulvodynia (persistent vulvar pain) and genital-pelvic pain dysfunction (often related to pelvic floor muscle tension) are two common types. Vulvodynia is usually described as burning, stinging, or rawness, while pelvic pain dysfunction may involve painful vaginal penetration, often described as “hitting a wall.”

Treatment Options: Treatment for sexual pain disorders often involves a combination of physical therapy (sometimes with biofeedback), use of lubricants, and/or counseling. Women with genital-pelvic pain dysfunction may benefit from relaxation techniques, vaginal dilators, or injections to manage pain and reduce muscle tension.

Endometriosis

Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus. This can cause intense pelvic pain, which often worsens during menstruation or sexual activity. Endometriosis can also impact fertility.

Treatment Options: Managing endometriosis often includes pain-relief medications, hormone therapies, or, in some cases, surgery to remove excess tissue. Lifestyle changes to reduce stress, along with counseling or support groups, may also help women manage this chronic condition.

Vulvar Skin Disorders

Vulvar skin disorders, like lichen sclerosus and lichen planus, involve chronic inflammation or changes in the vulvar skin. Lichen sclerosus can cause itching, burning, and structural changes, while lichen planus may involve painful red patches with lacy white borders on the skin.

Treatment Options: These conditions are often managed with topical ointments, which help soothe irritation and inflammation. In severe cases, surgery may be necessary to address structural issues. Counseling and support from healthcare providers are important to help manage the ongoing symptoms.

Female sexual dysfunction is a complex area of women’s health, but with the right support and treatment options, many women can find relief. If you experience any of these symptoms, consider reaching out to a healthcare provider to discuss your concerns and explore your options.

References:

• ISSWSH Slide Deck: Female Sexual Function and Dysfunction. (2023). International Society for the Study of Women’s Sexual Health.