Despite being prevalent, less than half of women experiencing sexual dysfunction seek medical help, according to a recent review.
Susan R. Davis, MB, BS, PhD, explored the multifactorial nature of sexual dysfunction, including biological, psychological, and sociocultural influences, and its substantial impact on quality of life.
She presented the case of a 54-year-old woman with low libido, reduced arousal, and anorgasmia following a hysterectomy and bilateral salpingo-oophorectomy. Despite transdermal and topical estradiol therapy, her symptoms persisted.
Davis recommended identifying any relationship challenges, major psychosocial influences, or modifiable factors, and assessing whether the decrease in libido was a significant concern for the patient. Should hypoactive sexual desire disorder be confirmed, relevant psychosocial factors should be addressed, and treatment options explored, she noted in her published feature in The New England Journal of Medicine. In many places, this would involve off-label pharmacotherapy, with the most evidence-based option currently being transdermal testosterone at a dose suitable for a female patient.
Psychosocial interventions are often beneficial in addressing sexual dysfunction. These may include sexual counseling, body awareness counseling, cognitive therapy, couples counseling, or referral to a psychologist if a mood disorder is present. Specific sexual therapies can also be used, such as pelvic-floor relaxation training, vaginal dilator therapy for women with vaginismus, and clitoral devices to enhance sensation and orgasm in those with arousal difficulties.
Several studies illustrate the prevalence of sexual dysfunction. A German study found that 19.4% of women aged 18 to 24 and 31.5% of women aged 46 to 55 experienced low sexual desire, while 6.2% of younger women and 7.3% of older women had hypoactive sexual desire disorder (HSDD) with distress. An Australian study reported similar findings, with 27.4% of younger women and 58.9% of women aged 45 to 49 reporting low desire. HSDD was observed in 12.2% of younger women and 31.6% of those in midlife, noted Davis.
Arousal dysfunction affects 3-9% of women aged 18 to 44, 5%-7.5% of women aged 45 to 64, and 3%-6% of women aged 65 and older. Anorgasmia with distress impacts 7%-8% of women under 40, 5-7% of women aged 40 to 64, and 3-6% of women aged 65 and older. Poor sexual self-image was reported by 13.4% of women under 40 in an Australian study, with 30% of participants experiencing sexually related distress without a specific sexual difficulty, added.
The International Society for the Study of Women’s Sexual Health has developed guidelines for identifying sexual concerns in women and assessing hypoactive sexual desire dysfunction. These guidelines serve as important tools to improve the expertise of both primary care providers and specialists in managing these issues.
While current therapies show promise, more research is needed to refine treatment strategies and explore new therapeutic options, particularly for conditions like arousal and orgasm dysfunction, where effective pharmacological solutions remain limited, said Davis.
As Aldous Huxley once said, "Medical science has made such tremendous progress that there is hardly a healthy human left." This quote highlights the ongoing challenges in addressing complex health issues like sexual dysfunction, where medical advancements sometimes fail to keep pace with patient needs.
