Sexual Dysfunction in Women: An Overview of Psychological/Psycho-social, Pathophysiological, Etiological Aspects and Treatment Strategies

Sex response in women is expressed by different phases (desire, arousal, lubrication, plateau, orgasm and resolution). Any divergence would lead to female sexual dysfunction (FSD), which cause distress and agony. The psychological factors incorporate inhibitions from personality, depression, angedonia, anxiety and coital pain. Such inhibitions would isolate women to seek pleasures in unnatural means of satisfaction. While the medical problems such as frail or gigantomastia, insignificant or clitoromegaly, adhesions, vaginismus can be treated by commercially available medicines and surgery, most of the psychogenic treatment is based on cognitive behavioral and psychodynamic approaches, including psychotherapy and counseling. The pathophysiological aspects of FSD are illustrated by due emphasis on the organic causes related with dyspareunia, anorgasmia, urinogenital complications, different diseases, effect of drugs, hormonal imbalance, hysterectomy, menopause and age related FSD. The jeopardy in sexual function begins with the lack of libido, vaginal dryness, decrease of blood flow, which cause erectile dysfunction of clitoris and failure of vaginal engorgement and finally dissatisfaction in achieving orgasm and resolution. These symptoms have no limitations of age, however; they aggravate after menopause and/or in aged women. Commercially available gels and creams are used against vaginal dryness and androgens are used to increase libido. Although, there are a number of oral/topical pharmacologic strategies available to increase flow of blood, recently Sildenafil citrate (Viagra) has gained importance to increase vaginal engorgement and clitoral erection. While, both natural and synthetic antioxidants play a vital role in the treatment of organic disorder, a number of drugs such as dehydroeplandrosterone (DHEA), bupropion, arginine, kyogreen, phytoestrogens, dong qui, horny goat weed, Lobelia, damiana, Siberian ginseng and herbal formulation of Muira puama and Ginkgo biloba (Herbal vX) are popularly used by women to have a beneficial effect. The other measures of treatment include hormone replacement therapy and employment of battery operated vibratory devices to treat sexual arousal and orgasm disorders. We analyze that the FSD is a common problem among women, irrespective of age and suggest that the women health providers should periodically examine the sexual activity of their patients. There should be a thorough screening for FSD and expert consultation be provided for treatment and counseling.