Sexual Dysfunction: What is it and how is it treated?

As a physical therapist specializing in women’s health and pelvic floor dysfunction, I encounter many women who are suffering from some form of sexual dysfunction, even if it’s not the primary issue for which they are seeking physical therapy treatment. As we launch into our Share MayFlowers month, we felt it important to touch on this very important and often over-looked issue.

What is sexual dysfunction? Sexual dysfunction is defined as any persistent, recurring problems with a person’s sexual response during a mutually consenting sexual experience, which then causes strain on a romantic relationship or altogether limits sexual activity.

Who experiences sexual dysfunction? The percentage of women in the US who experience sexual dysfunction varies significantly in the research, but what we do know is that it can be very common and often is under-reported to healthcare providers. Unfortunately, due to several different factors (less time available in a doctor’s office, not knowing sexual dysfunction can be treated, stigmas associated with a condition, etc.), many women do not seek treatment.

The risk factors for sexual dysfunction also vary widely, and are dependent upon the underlying cause, but some of the most common include: hormonal changes related to age or having children, injury or trauma to the pelvic area (whether from surgery, childbirth, falls, etc.), any infection or inflammation in the pelvic area (such as sexually transmitted infection, yeast infection, or urinary tract infection), as well as medical treatments for cancer which can potentially impact vaginal tissue and lubrication.

What are the symptoms of sexual dysfunction? These typically fall into one or more of the following categories:

  • Pain with sexual activity, including pain with sexual contact, such as stimulation, penetration, or thrusting
  • Changes in sexual desire
  • Changes in sexual arousal
  • Changes in genital sensation (more sensitivity, less sensitivity, absent sensation)
  • Changes in vaginal lubrication

What, then, is healthy sexual function? In short, healthy sexual function means the ability to participate in sexual activity as desired without any limitations. To continue our discussion on this, I will reference a great resource from Rosemary Basson in the Journal of Sex and Marital Therapy that is available online. She describes in her research that the female sexual response cycle (especially for those in long-term, committed relationships) can vary dramatically from the male cycle, which has been historically used in diagnosing sexual dysfunction. For example, a female’s motivation or desire for sexual activity can look drastically different from a male counterpart, especially since female sexual desire is not always driven by a physical need for sexual release. In addition, sexual arousal may not necessarily be linked with physical changes (such as increased lubrication), nor does orgasm release always have to occur in the female sexual cycle. The distinction between genders is important, because the female cycle can be influenced by several factors which are not necessarily part of the male cycle.

In a female sexual experience, there are multiple factors that can either enhance or inhibit the physical and emotional response. These can include the emotional connection with a partner; any concerns for safety during a sexual experience (which can include physical safety, but also encompasses concern for sexually transmitted infection or pregnancy); the timing and location of the sexual experience; your individual self-image and emotional health; any prior sexual experiences and expectations for your current sexual relationship; as well as any medication use which may affect sexual response and mental health and well-being.

All of these factors play a significant role in your body’s physical response, but are also significant in determining overall satisfaction associated with a sexual experience. In other words, the physical response alone cannot be the sole diagnostic tool and other areas need to be considered to determine the root cause of sexual dysfunction.

When should I see a doctor or other medical professional? Ask yourself these questions:

  • Am I sexually active?
    • If no, do I see that as a problem?
    • If in a relationship and not sexually active, does my partner see that as a problem?
    • If yes, are there any concerns or questions about my sexual relationship?
  • Am I having any discomfort with sexual activity that is troublesome?
  • Am I concerned about my or my partner’s satisfaction with our sexual relationship?

If you have answered “yes” to any of these questions, talk with your doctor to discuss treatment options. Be sure to discuss your symptoms as fully as you can to get an accurate diagnosis and treatment plan. Your doctor will likely first want to rule out any underlying infection or other issue which may be contributing to your symptoms.

How is sexual dysfunction treated? Treatment for sexual dysfunction includes many different options, such as the following:

  • Pelvic Floor Physical Therapy: a specialty within physical therapy that focuses on incorporating evaluation and rehabilitation of the pelvic floor muscles (which participate in sexual function, as well as bowel and bladder control, pelvic organ support, and core stability) to the overall rehabilitation experience
  • Alternative therapies such as yoga and acupuncture
  • Mental health counseling
  • Home modifications to improve the sexual response and experience:
    • Changes in sexual positions
    • Use of vaginal lubricant
    • More time for foreplay
    • Changes in environment (lighting, location, etc.)
    • Communication with your partner to discuss ways to improve the sexual experience
  • Medical treatments
    • Medications for pain relief or muscle relaxatio
    • Surgical intervention to address such issues as cysts or lesions

Please know that if you are experiencing sexual symptoms, you are not alone! There are resources to help you and your partner experience the sexual relationship you desire. In addition to those listed below, please also be sure to check out the list of resources on the Share MayFlowers website.

The following organizations have information regarding female pelvic pain in particular, which may be helpful:

And if you are interested in finding a physical therapist specializing in women’s health and pelvic floor dysfunction, the following resources may be helpful:

  • www.apta.org Click on “Find a PT”. Select “Women’s Health” as the specialty area from the drop down menu and search in your area.
  • www.hermanwallace.com Click on “Practitioner Directory” to search in your area.

Amy Boutry, PT, DPT Physical Therapist, Marathon Physical Therapy and Sports Medicine