Sexual Dysfunction in Female

Female sexual dysfunction (in other words, FSD) has traditionally included disorders of desire, arousal, pain, and muted orgasm. The associated risk factors for FSD are similar to those in males i.e.: cardiovascular disease, endocrine disorders, hypertension, neurologic disorders, and smoking.

Epidemiologic data are limited, but the available estimates suggest that as many as 43% of women complain of at least one sexual problem. Despite the recent interest in organic causes of FSD, desire also arousal phase disorders remain the most common presenting problems when surveyed in a community-based population.

[1] Sexual Desire Disorder or Hypoactive sexual desire disorder

• Decreased libido is characterized by a lack of or absence for some time of sexual desire or libido for sexual activity or of sexual fantasies.

Causes:

• Decrease in the production of normal estrogen in women.
• Ageing,
• Fatigue,
• Pregnancy,
• Medications (such as the SSRIs) or psychiatric conditions, such as depression and anxiety.

[2] Sexual Arousal Disorder

• Sexual arousal disorders were previously known as frigidity in women.
• Frigidity has been replaced with a number of terms describing specific problems that can be broken down into four categories as described by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders: lack of desire, lack of arousal, pain during intercourse, and lack of orgasm.
• For people of all genders, these conditions can manifest themselves as an aversion to and avoidance of sexual contact with a partner.
• In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity.
• There may be physiological origins to these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease can also contribute, as well as the nature of the relationship between the partners.

[3] Orgasm Disorder

• Anorgasmia

It is classified as persistent delays or absence of orgasm following a normal sexual excitement phase in at least 75% of sexual encounters. The disorder can have physical, psychological, or pharmacological origins. SSRI antidepressants are a common pharmaceutical culprit, as they can delay orgasm or eliminate it entirely. A common physiological culprit of anorgasmia is menopause; one in three women report problems obtaining an orgasm during sexual stimulation following menopause.

• Premature Ejaculation

It is when ejaculation occurs before the partner achieves orgasm, or a mutually satisfactory length of time has passed during intercourse. There is no correct length of time for intercourse to last, but generally, premature ejaculation is thought to occur when ejaculation occurs in under two minutes from the time of the insertion of the penis. For a diagnosis, the patient must have a chronic history of premature ejaculation, poor ejaculatory control, and the problem must cause feelings of dissatisfaction as well as distress the patient, the partner or both.

• Historically attributed to psychological causes, new theories suggest that premature ejaculation may have an underlying neurobiological cause which may lead to rapid ejaculation.
• Post-orgasmic Disorder

It symptoms shortly after orgasm or ejaculation. Post-coital tristesse (PCT) is a feeling of melancholy and anxiety after sexual intercourse that lasts for up to two hours.

• POIS may involve adrenergic symptoms: rapid breathing, paranesthesia, palpitations, headaches, aphasia, nausea, itchy eyes, fever, muscle pain and weakness and fatigue.
• The etiology of this condition is unknown; but it may present as anxiety relating to coital activities and thus may be incorrectly diagnosed as such. There is no known cure or treatment.

[4] Sexual pain Disorder

Sexual pain disorders in women include dyspareunia and vaginismus .

Causes:

• Insufficient lubrication in women. Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause, pregnancy, or breastfeeding.
• Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex.
• It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma may play a role.
• Another female sexual pain disorder is called vulvodynia or vulvar vestibuli is. In this condition, women experience burning pain during sex which seems to be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown.

• Neurologic disease: stroke, spinal cord injury, parkinsonism Trauma, genital surgery, radiation
• Endocrinopathies: diabetes, hyperprolactinemia Liver and/or renal failure
• Cardiovascular disease
• Psychological factors and interpersonal relationship disorders: sexual abuse, life stressors
• Medications: Antiandrogens, Antidepressants, Antioestrogens or GnRH antagonists, Antihistamines, Antihypertensives, diuretics, Alkylating agents, Anticholinergics

The female sexual response requires the presence of estrogens. A role for androgens is also likely but less well established. In the CNS, estrogens and androgens work synergistically to enhance sexual arousal and response.

A number of studies reports enhanced libido in women during preovulatory phases of the menstrual cycle, suggesting that hormones involved in the ovulatory surge (e.g., estrogens) increase desire. Sexual motivation is heavily influenced by context, including the environment and partner factors.

Once sufficient sexual desire is reached, sexual arousal is mediated by the central and autonomic nervous systems. Cerebral sympathetic outflow is thought to increase desire, and peripheral parasympathetic activity results in clitoral Vaso congestion and vaginal secretion (lubrication).

The neurotransmitters for clitoral corporal engorgement are similar to those in the male, with a prominent role for neural, smooth-muscle, and endothelial released nitric oxide (NO).

Other Factors

A fine network of vaginal nerves and arterioles promotes a vaginal transudate. The major transmitters of this complex vaginal response are not certain, but roles for NO and Vaso intestinal polypeptide (VIP) are suspected.

Investigators studying the normal female sexual response have challenged the long-held construct of a linear and unmitigated relationship between initial desire, arousal, Vaso congestion, lubrication, and eventual orgasm.

Caregivers should consider a paradigm of a positive emotional and physical outcome with one, many, or no orgasmic peak and release.

Although there are anatomic differences as well as variation in the density of vascular and neural beds in males and females, the primary effectors of sexual response are strikingly similar. Intact sensation is important for arousal.

Thus, reduced levels of sexual functioning are more common in women with peripheral neuropathies (e.g., diabetes). Vaginal Lubrication is a transudate of serum that results from the increased pelvic blood flow associated with arousal.

Vascular insufficiency from a variety of causes may compromise adequate lubrication and result in dyspareunia. Cavernosal and arteriole smooth-muscle relaxation occurs via increased nitric oxide synthase (NOS) activity and produces engorgement in the clitoris and the surrounding vestibule.

Orgasm requires an intact sympathetic outflow tract; hence, orgasmic disorders are common in female patients with spinal cord injuries.

It may Classified in to 4 categories i.e.

[1] Firstly, Hypoactive sexual desire disorder

[2] Secondly, Sexual Arousal Disorder

[3] Thirdly, Orgasm Disorder

[4] Fourthly, Sexual pain Disorder

• Serum Prolactin
• Serum Oestrogen
• Gonadotropins
• CBC
• Blood sugar level
• Lipid Profile
• Thyroid profile

• History medical, surgical, obstetric, psychological, gynecologic, sexual, and social information. Past experiences, intimacy, knowledge, and partner availability should also be ascertained.
• Medical disorders that may affect sexual health should be delineated. They include diabetes, cardiovascular disease, gynecologic conditions, obstetric history, depression, anxiety disorders, and neurologic disease.
• Medications should be reviewed as they may affect arousal, libido, and orgasm.
• The need for counselling and recognizing life stresses should be identified.
• The physical examination should Assess the genitalia, including the clitoris, Pelvic floor examination may identify prolapse or other disorders.
• Laboratory studies are needed, especially if menopausal status is uncertain. Estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) are usually obtained, and dehydroepiandrosterone (DHEA) should be considered as it reflects adrenal androgen secretion.
• Liver function assessment, and Lipid studies may be useful, if not otherwise obtained. Complicated diagnostic Evaluations such as clitoral Doppler Ultrasonography and biothesiometry require expensive equipment and are of uncertain utility. It is Important for the patient to identify which symptoms Are most distressing.
• The Evaluation of FSD previously occurred mainly in a psychosocial context. However, inconsistencies between diagnostic categories based only on psychosocial Considerations and the emerging Recognition of organic.

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Homeopathic Medicines for Sexual Dysfunction in Female :

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:

SEPIA:

• It is a good remedy for FSD.
• Sepia woman is highly irritable, sensitive, and angry, easily offended and miserable due to weak uterine problems.
• Low sex drive is due to the relaxation of pelvic muscles, and there is a bearing down sensation as if everything would escape through the vagina.
• Aversion to coition due to prolapsed of uterus and vagina wall.
• Frigidity from childbirth after weaning or hormone pills.
• Nausea and irritability on thought of sex.
• Great weakness after sex. Aversion to whom she loved best and other family members.

AGNUS CASTUS:

• Sexual desire almost absent.
• Sexual thrill absent due to excessive masturbation.
• Aversion to sex.
• Relaxation of genitals with leucorrhoea.
• Great sadness, depression and sexual melancholy.
• Diminished sexual desire with complete prostration and general debility.

BERBERIS VULGARIS:

• Berberis vulgaris is suitable to listless, apathetic also indifferent woman.
• Sexual desire absent due to pain during coition.
• Cutting, stitching pains during coition. In detail, Vaginismus.
• Vagina very sensitive, pinching constriction in mons veneris, contraction also tenderness of vagina.
• Burning and soreness in vagina after intercourse.
• Enjoyment absents during sex. Besides this, Great prostration after sex.
• Neuralgia of ovaries and vagina are other factors for low sex drive.

ONOSMODIUM:

• Onosmodium is another effective medicine for low sex drive in woman.
• Sexual desire completely absent due to uterine pain and bearing down pains.
• Soreness of ovaries with rectum.
• The woman has low power of concentration and co-ordination.
• She has early and prolonged menses, Great prostration, weak, timid. Often suffers from migraine headache.
• Sexual neurasthenia, weariness, tiredness in legs.

STAPHYSAGRIA:

• Aversion to sex due to past history of rape or sexual abuse.
• Vaginismus, vagina is very sensitive to touch.
• Ovarian pain, going into thighs, worse pressure or sex.
• Prolapse with sinking feeling in the abdomen.
• Staphysagria patient often prefers solitude.
• Frequent urinary infection, which is worse from intercourse.

IGNATIA MARA :

• Best indicated medicine in FSD.
• Sexual desire absent, especially in vehement woman.
• They are moody, emotional, sensitive and easily excited.
• Aversion to sex due to vaginismus, vagina very sensitive.
• Intense pain at the entrance of vagina during coition with burning heat.
• Sexual desire absents after grief, shock, disappointment, frustration, and worry. Patient is worse after coition.

HELONIU

• Tendency to inflammation of vulva also vagina, with formation of pus.
• Persistent itching of genitals either with or without formation of blisters or sores.
• Foul smelling leucorrhea.

PLATINA

• Nervous, spasmodic women; great tenderness of vulva.
• Nymphomania. Additionally, Excessive sexual development.
• Pruritus vulvae. Ovaritis with sterility.
• Abnormal sexual appetite also melancholia

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• Getting regular exercise
• Eating a varied and nutritious diet
• Maintaining a healthy weight
• Limiting alcohol consumption and avoiding tobacco use
• Sharing intimate times with a partner that do not involve sex.

What is Sexual Dysfunction in Female ?

The World Health Organization defines sexual dysfunction as a “person’s” inability to participate in a sexual relationship as they would wish”.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Sexual Dysfunction in Female ?

• Sepia
• Agnus Castus
• Berberis Vulgaris
• Onosmodium
• Staphysagria
• Ignatia Amara

What are the 4 types of Sexual Dysfunction in Female ?

• Sexual Desire Disorder
• Orgasm Disorder
• Sexual pain Disorder

What causes Sexual Dysfunction in Female ?

• Decrease in the production of normal estrogen in women.
• Ageing
• Fatigue
• Pregnancy
• Medications
• Psychiatric conditions (depression and anxiety)

1] Harrison-s_Principles_of_Internal_Medicine-_19th_Edition-_2_Volume_Set

[2] Homoeopathic Therapeutics by Lilienthal

[3] https://www.healthline.com/health/erectile-dysfunction/foods-diet#cocoa

[4] https://www.rajeevclinic.com/disease/gynaecology