Fluctuating desires

All Woman

Fluctuating desires


Monday, August 19, 2019

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THE moment we hear the term sexual dysfunction many of us begin to conjure images of a rather embarrassed man in the middle of a heated love session struggling to keep an erection. But while these challenges are more easily identifiable in men, obstetrician gynaecologist Dr Robyn Khemlani said that women are also affected by these conditions.

“Female sexual dysfunction encompasses various conditions that are characterised by reported personal distress in one or more of the following areas: desire, arousal, orgasm, or pain. Although female sexual dysfunction is relatively prevalent, women are unlikely to discuss it with their health care providers unless asked,” Dr Khemlani told All Woman.

She pointed out that the condition can affect any woman at any stage of life. However, she said that the causative factor is usually linked to the disruption of one or more elements at play such as physiology, emotions, experiences, beliefs, lifestyle, and relationships.

“Female sexual interest or arousal disorder is one of the most common sexual dysfunctions that women complain about. It is marked by fluctuation in sexual interest and arousal and can occur throughout the woman's life,” Dr Khemlani said.

She notes that many factors can contribute to a lack of sexual desire; including stress, changes in body image, shape, weight, pregnancy, breastfeeding, a sedentary lifestyle, alcohol or other substance abuse, changes in sleep patterns or chronic poor quality sleep, and relationship factors.

“Many women who say they lack sex drive or libido mean they have lost the physiological desire for sex. They describe thinking about sex, but their thoughts are about avoidance of sexual activity or about initiation or engagement in sexual activity to preserve the relationship or for their partner's benefit. Women also describe a distressing loss of interest, but an ability to become aroused in response to a partner's initiation of sexual activity,” Dr Khemlani explained.

Another commonly seen type of female sexual dysfunction is female orgasmic disorder. She said that this defined as a marked delay in, infrequency of, or absence of orgasm, or markedly reduced intensity of orgasmic sensations.

“Women with primary orgasmic disorder usually have normal levels of sexual desire. Most orgasmic disorders are acquired in relation to a new-onset medical, anatomical, relational, behavioural, or psychological conditions that commonly occurs with sexual interest and arousal difficulties or genito-pelvic pain and penetration disorder symptoms,” the doctor outlined.

Dr Khemlani said that in the case of genito-pelvic pain and penetration disorder, another form of sexual dysfunction, women who are affected either acquire the condition or have had it all their lives.

“Genito-pelvic pain and penetration disorder includes one or more of the following symptoms: tightening of the vaginal muscle with decreased ability or inability to accommodate penetration; tension, pain or burning feeling when penetration is attempted, a decrease in or no desire to have intercourse, avoidance of sexual activity, intense phobia or fear of pain,” she said.

Symptoms of genito-pelvic pain and penetration disorder, according to Dr Khemlani, often occur and have overlapping medical, situational and psychosocial causes and resolve in response to treatment of those conditions.

Many of the common culprits of dissatisfaction or dysfunction, Dr Khemlani said, are often interrelated and are generally categorised as physical or psychological.

“A physical causative factor may be any number of medical conditions including cancer, heart disease and bladder problems. Certain medications, including some antidepressants, blood pressure medications, antihistamines, and chemotherapy drugs can decrease your sexual desire and your body's ability to experience orgasm.”

She said that other conditions, such as challenges with hormones, and lower oestrogen levels, in particular, can also cause sexual dysfunction. Lower oestrogen levels are often seen in women following menopause.

“Following menopause, there is also the possibility that the vaginal lining will also become thinner and less elastic, particularly if you're not sexually active. These factors can lead to painful intercourse (dyspareunia). Sexual desire also decreases when hormonal levels decrease,” Dr Khemlani said.

She acknowledged that a temporary shift in your body's hormone levels can also result in sexual dysfunction. One of the best examples of when this could happen is after giving birth and during breastfeeding since both of these can lead to vaginal dryness and can affect your desire to have sex.

Psychological and social reasons causing sexual dysfunction, on the other hand, often occur as a result of untreated anxiety or depression. However, Dr Khemlani said that these are not the only contributors.

“Long-term stress, a history of sexual abuse, the worries of pregnancy and the demands of being a new mother are other factors that may have similar effects on women. Then there is the issue of long-standing conflicts with your partner — about sex or other aspects of your relationship — which may also diminish your sexual responsiveness as well. Cultural and religious issues and problems with body image also can contribute.”

The doctor said that the first step to addressing the problem of female sexual dysfunction is to first identify the cause of the problem.

“Because female sexual dysfunction has many possible symptoms and causes, treatment varies. Your goals for your sex life are important for choosing treatment and evaluating whether or not it's working for you. Women with sexual concerns most often benefit from a combined treatment approach that addresses medical as well as relationship and emotional issues,” Dr Khlemlani advised.

She explained that your physician may recommend consultation with or referral to mental health specialists with expertise and training in the treatment of female sexual dysfunction (for example, sex therapists, psychologists, psychiatrists, and marriage/relationship counsellors).

“Therapy often includes education about how to optimise your body's sexual response, ways to enhance intimacy with your partner, and recommendations for reading material or couples' exercises. You are also encouraged to talk and listen (to your partner). Open communication with your partner makes a world of difference in your sexual satisfaction. Even if you're not used to talking about your likes and dislikes, learning to do so and providing feedback in a non-threatening way sets the stage for greater intimacy,” Dr Khemlani underscored.

If the problem is found to be physical then the problem may improve with better management of the condition or a change in medication, for example. Some medications can affect hormone levels and emotions which might, in turn, affect desire.

Other medical intervention methods that might help or offer some relief include lubricants and moisturisers. Dr Khemlani said that while these do not cure the underlying causes of female sexual dysfunction, they may help reduce or alleviate dyspareunia that is due to vaginal dryness. Use of a sexual stimulation device may increase your chances of arousal, and of course, there is the issue of adapting and practising healthy lifestyle habits.

“These new habits should include limiting alcohol intake, since drinking too much can blunt your sexual responsiveness. Be physically active because regular physical activity can increase your stamina and elevate your mood, enhancing romantic feelings. It would also be beneficial to learn ways to decrease stress so you can focus on and enjoy sexual experiences,” Dr Khemlani advised.

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