Sexual Function
Women are not ‘little men’. A woman's sexual function is complex and is affected by many physiological and emotional factors, depending on her age, relationship status, cultural background, spiritual belief system and sexual identity. Issues with desire, arousal, orgasm, and pain are common.
Lifestyle habits, physical and mental wellness, self-esteem and body image all play an important role in a woman’s sexual function. Beneath the skin but equally important, there in an orchestra of physiology at play, (neurologic, muscular, vascular, anatomical and hormonal) that are integral for a woman to flourish sexually.
When any of these elements are out of balance, problems with sexual desire, arousal, orgasm, and vulvar/vaginal pain can occur. The necessity for treatment depends on whether a woman is distressed by her condition. This may manifest as frustration, guilt, feeling incompetent, grief, loss or worry. At Zen Medical Care you can learn about modalities of therapy. There is no need to suffer in silence!
SEXUAL DESIRE:
What is It?
Sexual desire is a strong feeling of wanting to engage in sexual activity, triggered by sex hormones and is affected by the menstrual cycle, perimenopause and menopause. It naturally fluctuates throughout adulthood. When a woman’s lack of interest in sex concerns her and causes distress, she may have hypoactive sexual desire disorder.
Causes:
Lack of sexual desire can be due to depression, physical illness, a history of trauma, pelvic pain, hormonal imbalance or significant dissatisfaction with a sexual partner.
Diagnosis: Since there are many causes behind this condition, a thorough evaluation of the underlying psychological, interpersonal and cultural causes is the optimal approach. Thorough screening through extensive questionnaires and a focused medical history along with the appropriate blood tests and a pelvic exam are important steps in the diagnosis process. One size does not fit all.
Treatment:
Most women benefit from a multifaceted treatment approach. This may include sex education, psychotherapy (cognitive behavioral therapy, mindfulness techniques, and sensate focus), medication, hormone therapy, lifestyle changes such as the increase in exercise and improved stress management and communication with a partner. Some women will benefit more from medication options, and some from an integrated approach including, psychotherapy and sexual therapy.
At Zen Medical Care each woman is carefully listened to face to face in order to create a focused solution.
SEXUAL AROUSAL:
What is it?
Sexual arousal can be understood as a manifestation of sexual desire. The International Society for the Study of Women’s Sexual Health defines female sexual arousal disorder as the inability to develop or maintain an adequate genital response (lubrication, engorgement and sensitivity of the genitalia) to stimuli. It is important to note it is not one’s fault and that even if a woman’s desire for sex is intact, she may still have difficulty with arousal.
Causes:
Women require a feeling of emotional closeness, attachment and safety with the person they are engaging with in order to feel sexual arousal. Desire and physical arousal induces a feedback loop which potentially increases the level of excitement. If disruptions occur in this feedback loop, then sexual arousal can be affected.
Diagnosis:
Age, medical conditions, psychological and relationship factors play a critical role in diagnosing this disorder. In addition, significant distress about the level of arousal can exacerbate this condition. Women with persistent sexual arousal disorder should undergo a thorough biopsychosocial history, physical examination, and laboratory tests. It is also important to note that vulvovaginal infection/inflammation, vulvodynia (vulvar pain), clitorodynia, (clitoral pain) should be excluded before the diagnosis of female genital arousal is made.
Treatment: Non-pharmaceutical options can include the use of sexual toys, fantasy, role-play, increased intimacy with a sexual partner, etc. Lifestyle changes such as exercise, relaxation techniques and sleep hygiene can also be part of a treatment plan, as well as consultation with a psychotherapist. There is also the option of medication, including bioidentical hormones, medical grade green tea extract, and medical cannabis.
At Zen Medical Care all of these possible etiologies are addressed and comprehensive solutions offered.
ORGASM DISORDER:
What Is It?
The drive to experience orgasm occurs in part because they are associated with memorable events that are often expressed by as ecstasy, euphoria, and extreme pleasure. which acts to motivate a woman to experience orgasm in the future. Female orgasm disorder is the second most reported sexual problem for women. It is defined as a persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.
Causes:
The following are potential causes of this disorder: brain neurotransmitters imbalance, pelvic floor dysfunction/pain, partner’s sexual dysfunction, low testosterone and or estrogen levels, abnormal prolactin levels, genital skin conditions such as lichen sclerosis, or neurologic disorders, etc. Female orgasm disorder may exist in part from various factors which are important to identify as part of the diagnostic process
Diagnosis:
Appropriate blood tests are performed, physical pelvic examination, pelvic imaging (if needed), as well as a consultation with a pelvic physical therapist if indicated. A detailed psycho-social history is taken to identify any other factors.
Treatment: Treatment options are available such as psychotherapy including sensate focus and cognitive therapy, pelvic physical therapy, pharmacologic agents (including medical grade green tea extract and medical cannabis), topical vasodilator medication (dilation of local clitoral blood vessels) and bioidentical hormones.
At Zen Medical Care, the goal is to address sexual function issues in a way to ensure that a woman feels safe, open, and accepted by herself and with her sexual partner(s).
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