What Is Female Sexual Dysfunction?

By  //  February 1, 2012

Share on Facebook Share on Twitter Share on LinkedIn Share on Delicious Digg This Stumble This



Q: What is female sexual dysfunction (FSD)

A: Female sexual dysfunction (FSD) is a sexual problem, or sexual dysfunction that occurs during any phase of the sexual response cycle that results in a failure to achieve satisfaction from the sexual activity.

There are four phases that make up the sexual response cycle: Excitement, Plateau, Orgasm, and Resolution. During any of these phases there can be a problem that prevents a satisfying experience. FSD occurs in 43-44% of women during their lifetime compared to men who have an occurrence rate of around 31% (although some authors thank this may be considerably higher)

Most women are embarrassed by their sexual condition and are often reluctant to ask specific questions about their sexual concerns.

Sometimes their doctors are not even able to address them.  Almost all doctors lack the proper training required to adequately diagnose and treat FSD.  The doctors often tell their patients that nothing can be done about their problem and frequently say words to the effect, “Don’t worry, sex is not that important anyway, but if it is for you, there are some good books for you to read about it” and excuse themselves to see someone else that is sitting in their busy waiting room.

Q:  What causes FSD?

A:  Physical causes:  Medical or physical causes such as diabetes, heart disease, neurological diseases, hormonal imbalance, and chronic diseases like kidney or liver failure, alcoholism or drug abuse are among many of the causes of FSD.

More importantly, in relatively healthy people, side effects from commonly prescribed medicines, especially SSRI’S (Prozac, Paxil, etc.) are over prescribed for depression, and the side effects can devastate sexual desire (libido) and cause discord in an otherwise healthy relationship.

Psychological causes:  Stress (who doesn’t have it these days?), anxiety, depression, marital or relationship disharmony and concern about performance are common reasons for FSD.  Guilt and sexual trauma are also major contributors as over one-third of women have been sexually abused in their lifetime.

Q:  Who is affected by FSD?

A:  Both women and men are affected by FSD. Likewise, both men and women are affected by male sexual dysfunction. FSD can occur in all ages, especially as a person gets older, but equally, if not more devastatingly, it happens in young women, frequently after childbirth.

Additionally, women who are breast cancer survivors with body image issues from mastectomies, chemotherapy survivors who have lost their hair etc., have a particularly difficult time finding ways to regain a pleasurable sex life.

Q:  What specific ways does FSD affect women?

A:  Lack of libido (inhibited sexual desire) and lack of sexual desire, or low interest in sex is common in many women. What was once the highlight of their relationship is now of little or no importance. If not corrected, it can lead to a separation in the relationship.

Many times long absences of sex in a relationship can lead to episodes of infidelity, which often lead to the ultimate rift-divorce.  SSRIs, like Prozac and Paxil are often significant contributors to people having low or no desire to have sex.

Many times, women in their mid-thirties, who are starting perimenopause, complain of depressive symptoms, which may be the result of an hormonal imbalance such as low progesterone.

A lack of Progesterone, known as the “happy” hormone of pregnancy, may cause depression.  Women with a lack of Progesterone, don’t have a “prozac deficiency”, but rather need a boost  they just need a little progesterone.

When women are breastfeeding, the prolactin produced for milk stimulation, can also be a cause for lower progesterone levels. Most women’s sexual desire drops during breast-feeding for a variety of reasons.

Although it is not a reason to not breastfeed, there is some evidence to indicate that during times when the mother is breast feeding and appears to prefer that activity to sex, the husband may feel left out. Good understanding of what is happening during this time is important for both the mother and her husband.

Things can be done to help ease the feeling of separation, and sometimes counseling is necessary to restore the sexual part of the relationship.

Factors leading to an inability to become physically aroused: Stress caused by financial or employment issues, anxiety, health concerns, children in trouble, inadequate stimulation caused by a seemingly boring husband who looks more like Archie Bunker than the Brad Pitt you married, are frequent causes of non-arousal.

Additional physical factors causing an inability to become physically aroused are poor vaginal lubrication caused by an overuse of vaginal medications such as anti-fungal ones for yeast infections; inadequate vaginal hormonal balance and decreased blood flow to the vagina and the clitoris.

There are several factors that can lead to painful sexual intercourse  or Dyspareunia: Lack of vaginal lubrication (especially true of women over the age of 50 who are no longer using hormone replacement) is one of the most common causes of painful sex.

Overuse of antifungals for “yeast” infections can lead to significant changes in the structure of the vagina and surrounding tissue.

There is a small circle of tissue that is just outside of the vagina, which is largely dependent on having adequate testosterone for it to remain healthy.

If the testosterone amount is too low, because of the frequent use of anti-fungal medicines, or from using birth control pills for an extended period of  long time, this tissue becomes chronically stimulated.

Eventually the nerve endings are constantly firing and cause extreme pain.  This condition is called Vulvodynia and the pain often worsens.  Many women suffer for years because their doctors are unaware of the many causes of painful sex and  the doctors often don’t consider the root causes of Vulvodynia.

Once diagnosed properly, Vulvodynia may take a long time to cure and in some cases, surgery is necessary to remove the entire inflamed, over stimulated condition, before the vagina can return to normal.

Lack of orgasm or Anorgasmia. Many women lack the ability to Climax or Orgasm. Some women have never experienced an orgasm.

One of our colleagues in Germany had an 80-year-old woman who came to her because she had never experienced an orgasm.  She stated she wanted one before she died or she wouldn’t feel she had led a complete life. With proper evaluation and treatment by her highly trained doctor, who was a woman member of ISSWSH, the *0- year old achieved her first orgasm.  It was not to be her last.

As with the other causes of FSD, Anorgasmia has a multiplicity of causes. Although not always the primary root cause, psychological factors are often the cause for a lack of orgasm,  especially in the large number of women who have been traumatized sexually.

Q:  How is FSD diagnosed?

A:  A complete and thorough history is obtained.  It is critical that the history be very comprehensive and covers every detail of a women’s past history, medical, social, sexual, etc.

Included are specific questionnaires, such as the FSFI (Female Sexual Function Index) scoring system that helps the provider understand the nature of the sexual dysfunction.

Sometimes the answer to the problem is simple and the cure relatively easy. However more often than not, there are many factors that cause the sexual problems and they often require time and patience on the part of both the patient and provider.

A complete physical exam is always required and may often include a routine pap smear.  A complete pelvic exam is a must. It is important that a woman seek out a provider who is a Nurse Practitioner that specializes in women’s health.

A Women’s Health Nurse Practitioner (WHNP) or gynecologist who has a high interest in women’s sexual health is ideal. Look for the additional experience and knowledge of someone who has been trained and belongs to the International Society for the Study of Women’s Sexual Health (ISSWSH).

These providers have a worldwide network of associates who are experts in diagnosing and treating women with sexual dysfunction.

Unfortunately, most doctors, even gynecologists with four years of rigorous education in women’s health, have little or no training in these matters and frequently dismiss women’s complaints as either being a “yeast” or other vaginal infection or a psychological condition that they have no way of treating.

Recently, The American College of OBGYN, recognized the need to further train their doctors. However, in my opinion they have a long way to go before becoming true experts in the field. Until that time women should seek out a provider who is ISSWSH trained.

Q:  How is FSD treated?

A.  FSD can be treated and in almost all cases a cure can be found. Even the most difficult cases can be cured.  It often requires a team approach from a nurse, a doctor, a psychologist/sex therapist and a physical therapist.

It takes a dedicated team who are willing to LISTEN to a woman’s concerns and then take a systemic approach to finding the proper solution. Sometimes the answer lies in just replacing missing hormones (preferably using bio-identical hormones) or diagnosing a chronic infection.

Often, there are vulva conditions that can be diagnosed and treated that may have been previously missed. Often there are neurological conditions that can be relieved by physical therapy or other techniques, such as vaginal stimulation and/or muscle altering techniques.

In some cases, surgery is necessary to relieve painful areas. In the case of sexual abuse, psychotherapy or alternative therapy is almost always recommended.

Finally, the man may have sexual dysfunction of his own or be significantly affected by his partner so that often both need treatment for their individual and couple sexual dysfunction.

It is very important to recognize that it takes two to tango and treating the couple usually optimizes the end results.  Great sex in a marriage is essential for a long lasting and satisfying union.


MAKImd is a comprehensive health restoration practice located in Merritt Island, Florida, featuring innovative medical techniques that cater to both men and women.

Kristine Maki, WHNP, is uniquely qualified to provide a complete range of primary gynecological services to women of all ages. She is keenly interested in preserving the highest quality of life and is an advocate of Bioidentical Hormone Replacement Therapy.

Ms. Maki is licensed in Florida as a Registered Nurse and Nurse Practitioner, and is a Certified Women’s Health Nurse Practitioner.  She was educated at Methodist Hospital in Lubbock, TX and Ball State University in Indianapolis, IN. Ms. Maki practiced as a labor and delivery nurse and maternal fetal intensive  care nurse from 1988-2004, and is a member of the American Academy of Anti-Aging Medicine and the nternational Society for the Study of Women’s Sexual Health.


• Annual gynecologic exam including pap smear, if needed

• Bioidentical Hormone Replacement Therapy

• Aesthetics, Radiesse and Mesotherapy

• Non-surgical urge and stress incontinence program

• Gynecological problems, including female sexual dysfunction


Dr. Lance Maki attended California State University and flew jets as an Air Force pilot before attending medical school at Texas Tech University Medical School. He  completed his  residency in Obstetrics and Gynecology at Wright Patterson AFB/ Miami Valley Hospital/ Wright State University  in Dayton,  Ohio. 

Dr. Maki was an Air Force Flight Surgeon and Aerospace Physiologist, is board certified, and is a fellow in both OB/GYN and Anti -Aging/Functional Medicine.

Dr. Maki specializes in improving Erectile Dysfunction, energy levels,   physical conditioning, nutritional counseling and stress management.

MAKImd has a comprehensive program that identifies early risk factors for heart disease and provides steps for life saving intervention if necessary.


• 64 slice CTA (Coronary Ct Angiography)

• Liproprotein particle profile (risk factor assessment for heart attack and stroke)

• Bioidentical hormone replacement for women and men

• Brain maximization (evaluation and treatment)

• Lifestyle mentoring

• Nutritional counseling

• Structured exercise programs, specializing in stand-up paddle surfing.

All programs are custom made and highly personal. MakiMd offers a limited number of 24/7 personal physician programs where the doctor becomes involved in all aspects of health improvement.  MAKImd also helps couples maximize their intimate relationship to achieve increased quality of life, independence and vitality.  MAKImd is a process that maximizes patient youthfulness and helps to slow the body’s natural  tendency to age with time.