Female Sexual Dysfunction – Causes, Symptoms, & Treatment

Female sexual dysfunction is recurrent trouble with sexual desire, arousal, orgasm, or pain that may affect intimacy and quality of life. It is common at every age and is often related to fluctuations of hormones, co-morbid medical conditions, a woman’s mood, and relationship problems. Near-universal diagnosis requires a sensitive and evidence-based, holistic approach using licensed, regulated body-identical HRT where appropriate, alongside psychosexual support, pelvic health physiotherapy, and lifestyle measures. Early consultation with medical practitioners and hormone specialists can allow women access to individualised solutions and regain sexual health confidence.

What is Female Sexual Dysfunction?

Female sexual dysfunction is a medical definition of sustained problems with sexual desire, arousal, orgasm, or pain that are a source of distress or strain in relationships. It is distinct from fleeting issues caused by a passing illness, fatigue, or life stress, since symptoms are sustained, recur, and impact daily life. Clinicians classify the illness in four overlapping areas, namely low desire, problems with arousal, problems with orgasm, and syndromes of pain like dyspareunia and vaginismus.

According to Dr Kirstin R. Mitchell, PhD, et al. from the UK Natsal research team, they’ve developed the Natsal-SF scale to enhance the conceptual understanding of sexual wellbeing. The instrument separates everyday problems, which occur commonly in women, from persistent problems, which could suggest female sexual dysfunction. The research also discovered that sexual health is highly correlated with emotional well-being and relationship quality.

The Natsal case study demonstrates that women’s sexual dysfunction is most easily understood in the broader setting of physical, emotional, and relational well-being. Through measures such as the Natsal-SF scale, clinicians can offer advice without over-medicalising, offering women the appropriate assistance when required.

How Common is Female Sexual Dysfunction?

Female Sexual Dysfunction (FSD) is highly common among all age categories and stages of life. Studies validate that sexual concerns affect a large number of women, and prevalence rates range depending on methodology and research population features. It is also quite typical during times of hormone changes, such as perimenopause and postmenopause, where decreasing levels of estrogen have a significant effect on sexual functioning sexually.

According to the Natsal-3 study, a comprehensive probability sample survey of men and women aged 16-74 conducted across Britain by Dr. Catherine H. Mercer from the Research Department of Infection and Population Health. Based on the study, among the women who are now experiencing menopausal symptoms, 34.2% of these women reported lacking interest in sex, 12.9% had vaginal dryness, 16.3% experienced difficulty reaching climax, and 12.1% reported lack of enjoyment.

These results highlight the significance of FSD as a public health concern. Recognising these patterns allows practitioners and patients in a menopause clinic to discuss sexual functioning openly, helping to normalise experiences and reduce stigma. This approach forms the foundation for comprehensive care strategies that address the multi-symptomatic nature of female sexual dysfunction.

Symptoms of Female Sexual Dysfunction

Women’s sexual dysfunction can impact women in varying manners, typically disrupting both physical and psychological well-being, as well as relationships. Knowing what its symptoms are is a great initial step in seeking support, enhancing quality of life, and recovering sex confidence.

Below are the most common symptoms of female sexual dysfunction you need to look out for:

Low Sexual Desire (Hypoactive Sexual Desire Disorder)

Low sexual desire, also known as hypoactive sexual desire disorder, is a clinical issue when a lack of interest is persistent, troubling, and not explained by transitory life stress.

Guidelines from NICE report that vaginal oestrogen can be prescribed as a first-line treatment for genitourinary symptom features at menopause, including those who currently use systemic HRT initiated and monitored by a hormone specialist. Non-hormonal lubricant or moisturiser can be beneficial too; vaginal prasterone can be considered an alternative if oestrogen or non-hormonal therapy is intolerable or not successful.

Orgasmic Disorders

Orgasmic disorders are diagnosed when orgasms are slow to arrive, less robust, or do not occur at all with adequate stimulation. Women might say that they feel like they “get close” to release but can’t get there, or that their pleasure feels less strong than it used to be. Anxiety, thinking too much about performance, and medication side effects can all be contributing factors. The inability to reach orgasm can bring disappointment, less enthusiasm for intimacy, and strain on relationships. With time, this problem can diminish confidence and serve to widen a cycle of dysfunction, particularly if it soon also quenches enthusiasm.

Pain During Sex (Dyspareunia and Vaginismus)

Dyspareunia is pain with intercourse, while vaginismus is involuntary pelvic floor tightening that blocks penetration. After menopause, oestrogen loss can thin and dry vaginal tissue, making sex uncomfortable. Vaginal dryness and discomfort often come from changes after menopause, and the fear of pain can make muscles tense up, creating a difficult cycle to break. Ongoing discomfort can lower self-confidence, make people worry about how their partner will react, and lead to avoiding closeness altogether. If not dealt with, pain can reduce sexual desire and arousal, making the negative impact on sexual health and emotional well-being even worse.

Arousal Difficulties

Arousal problems include a lack of lubrication or difficulty maintaining physical preparation even when libido is present. Arousal difficulties occur when you feel interested in intimacy but your body does not respond as expected. Common signs include reduced lubrication, diminished warmth, or loss of arousal during the experience. These changes may result from health issues, medications, or emotional factors. In some women, low testosterone can also reduce arousal, and tailored testosterone therapy for women may help restore desire and responsiveness.

These frequent issues might cause stress and confusion, yet it is also significant to consider what occurs to induce female sexual dysfunction because it might affect physical functions as well as mental health.

Causes of Female Sexual Dysfunction

Female sexual dysfunction is extremely unlikely to result from a single cause. More often than not, it proceeds from biological changes, emotional health, medical problems, and lifestyle patterns.

Below are the most common causes of FSD you need to be aware of:

Hormonal Factors

Hormones heavily influence sexual function. Oestrogen maintains vaginal lining elasticity and produces natural wetness; when it falls during and after menopause, most women can feel dryness or discomfort during sex. Some women also produce low levels of androgens, decreasing sexual interest.

In the United Kingdom, body-identical HRT is typically first for genitourinary syndrome treatment, while monitored-for-testosterone can be discussed for postmenopausal women still with low libido after other issues are corrected. Issues with the thyroid and adrenal glands can also decrease energy and mood, which can indirectly influence sexual interest. Awareness of these biological factors ensures women receive safe and specific treatments while excluding unnecessary or inappropriate ones.

Psychological and Emotional Factors

Anxiety, depression, or unresolved trauma can all suppress desire, increase muscle tension, and disturb orgasm. Relationship difficulties, difficulties with communicative talking, and body dissatisfaction are often part of the issue. For many women, stress at work or home continues to affect intimacy and emotional closeness.

According to Rosemary Basson from The University of British Columbia, Canada, et al., the greatest significant risk factor for female sexual dysfunction is mental health impairment. Despite their frequent sexual challenges, women with mental illnesses view sexuality as a significant part of their quality of life.

Psychological treatments such as cognitive behavioural strategies, mindfulness, and psychosexual therapy can reduce avoidance, rebuild trust, and increase intimacy.

Medical and Lifestyle Factors

Health conditions and daily habits significantly influence sexual function. Conditions such as diabetes, heart disease, pelvic floor disorders, and endometriosis can impact blood flow, hormone balance, and pain sensitivity. Additionally, certain medications, especially antidepressants and certain blood pressure drugs, may dampen libido or prolong orgasm.

Razie Hasheminezhad from the Community Health Research Centre, Isfahan, Iran, et al. found that physical exercise lowers sexual dysfunction in women, whereas inactivity leads to greater difficulties. This is due to interpersonal connections, which have a detrimental influence on quality of life.

Risk Factors for Menopause and Sexual Dysfunction

Sexual problems most commonly arise from many factors existing all together at once, in place of one cause alone. Risk is greatest at menopause when estrogen is lowest, after birth trauma to the pelvic area, and with current medical conditions.

In Britain, based on the research of Dr. George B. Ploubidis of Hygiene & Tropical Medicine, London Natsal-3 (Third National Survey of Sexual Attitudes and Lifestyles) was conducted and reported that, sexual function was firmly connected to depression and low self-rated health, and problems with relationships, such as difficulty discussing their sex and unhappiness in their relationship. Among sexually active individuals, difficulties with sexual response were prevalent, but being worried about their sex lives was less prevalent. This reflects a gap between experiencing symptoms and obtaining help.

Knowing these risks helps provide prompt and appropriate care. Thoughtful discussions can assist doctors in understanding issues related to the effective diagnosis of female sexual dysfunction in women.

Diagnosis of Female Sexual Dysfunction

The diagnosis of female sexual dysfunction is based on difficulties in one or more areas of sexual response, such as desire, arousal, orgasm, or pain during intercourse. For a proper diagnosis, symptoms must cause significant personal distress and negatively impact a woman’s health or quality of life. Physicians should also recognise that multiple conditions often occur together, so it is important to consider relationship dynamics and the well-being of both partners.

According to Kevan Wylie, a Consultant in Sexual Medicine from Sheffield, UK, she claims that diagnosis mainly depends on the patient’s history and careful questioning. Women might speak indirectly at first, so asking open questions like “Are you happy with your sexual life?” can help them share more. A thorough examination looks at biological, emotional, and mental factors, along with important medical issues like diabetes or neurological problems.

Understanding the complete situation leads to a better diagnosis and helps in discussing treatment options for female sexual dysfunction.

Available Treatment Plans for Female Sexual Dysfunction

A thorough assessment that includes a comprehensive medical history, a physical examination, and, if necessary, specific investigations is the first step in treating female sexual dysfunction (FSD). Priority is given to identifying underlying conditions, including endometriosis, pelvic inflammatory disease, or tumours, particularly in cases of severe pelvic pain.

Below are available treatment plans for FSD:

• Changes in Lifestyle: Changes that improve general health and sexual receptivity include regular exercise, a balanced diet, improved sleep, and giving up alcohol and tobacco.
• Pelvic Floor Exercises: In addition to improving control and sensitivity, strengthening the pelvic muscles can help get rid of genital or pelvic discomfort. Many women benefit from these simple, effective exercises.
• Psychoeducation and Psychosexual Therapy: Relationship problems, body dissatisfaction, anxiety, and traumatic experiences can all be resolved with treatment. Education aids in reducing avoidance and clarifying what constitutes a natural sexual response.
• Medical Treatments: Medical treatments include lubricants for comfort, local oestrogen for vaginal dryness, or medications such as tricyclic antidepressants and other psychotropics for particular pain syndromes. By enhancing the pleasure response, bupropion, a norepinephrine–dopamine reuptake inhibitor, has demonstrated effectiveness in treating arousal and orgasmic disorders.

Together, these approaches highlight that treatment is rarely one-size-fits-all but instead works best when options are combined and reviewed over time. These techniques are included in optimal therapy, which addresses the relational, emotional, and physical components. Seeking professional guidance ensures that care remains safe, effective, and aligned with personal goals.

When to See a Doctor About Female Sexual Dysfunction

Seek medical help if symptoms like poor libido, arousal problems, painful sex, or trouble reaching climax last for several months and start to affect your relationship or health. See a doctor right away if you experience any unanticipated bleeding, severe pain, or other unsettling side effects with a new medication.

In the UK, your first step should be to consult a hormone specialist, who can assess whether changes in oestrogen or other hormones are contributing to your symptoms. They can prescribe appropriate treatment, such as vaginal oestrogen, to relieve dryness and discomfort. To make the most of your appointment, note down your symptoms, when they began, and any possible triggers.

If you are experiencing ongoing symptoms, all our specialists are happy to discuss your sexual life and help identify and treat sexual problems. Contact Hormone Health for an evidence-based, compassionate professional care to help women move forward with confidence.