Dear Dr. G.

I understand you are a urologist and are usually answering questions related to men but I hope that you can help me unravel some issues I have with my wife.

My wife and I are both in our mid-forties, and have been married for more than ten years

We have no children and are quite happy with being a childless couple as both of us are very career-driven and treasure our companionship.

Now, both of us are in senior management positions, and we are reflecting on our relationship, especially when it comes to bedroom matters.

My wife is usually not keen on sex, and often blames it on tiredness.

On the occasions we have sex, she complains of pain during penetrative intercourse.

As a result, we have been in a sexless marriage for many years.

As we aged, we started communicating more about such taboo subjects and hoping to enhance our sexual relationship.

I reckon my wife may suffer from female sexual dysfunction. Hence, I have built up the courage to put Dr. G on the spot for clarification.

What exactly is female sexual dysfunction and what are the usual symptoms to look out for?

Are there any treatments available to enhance female sexual functions?

If so, are there risks in accepting the treatment.

Looking forward to your answers.

Yours truly,

Sexless Sydney

Female Sexual Dysfunction is characterised by recurrent problems with lack of sexual responses, low desire, inability to achieve orgasm or pain during sexual activities resulting in distress or strain on sexual relationships.

There are generally four subtypes of Female Sexual Dysfunction and the diagnosis requires careful sexual history taking to differentiate the different aspects of the dysfunction. This most common dysfunctions involve a lack of sexual interest and a lack of willingness to be sexual resulting in low sexual desire.

On the other hand, the desire for sex might be intact, but the difficulty comes with getting or staying aroused. Another facet is a persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation.

Lastly, pain associated with sexual stimulation or vaginal contact is also a common disorder that puts a strain in sexual relationships.

Sexual responses are a complex interplay of physiology, emotions, experiences, upbringing, lifestyle and relationship. Of course, the disruption of any component can affect the desire, arousal and satisfactions in any individual.

Female sexual dysfunction can occur at any stage of life. It can also occur only in certain sexual relationships and be absent in others. For many women, transient setbacks in sexual function are inevitable at some point in life, for others the difficulties may be have been present throughout their life.

The aetiology of Female Sexual Dysfunction stems from physical, hormonal and psychological causes. Medical conditions such as cervical cancer, neurological disorder, or urinary tract infections can lead to female sexual dysfunction.

Medications such as antidepressants, antihypertensives, antihistamines and chemotherapy are well-recognised to decrease sexual appetite and orgasm.

Additionally, lower oestrogen levels after menopause cause changes in genital tissues and sexual responsiveness. A decrease in oestrogen leads to decreased blood flow to the pelvic region, resulting in less genital sensation and prolonging interval to climax.

Long-standing conflicts with your partner about sex or other aspects of relationship also may diminish your sexual responsiveness. Additionally, cultural and religious issues and a negative body image may also dampen sexual function.

Lastly, untreated anxiety or depression and the worries of pregnancy and the demands of being a new mother are all psychological burdens that will dampen sexual pleasure.

Effective treatment for sexual dysfunction often requires addressing an underlying medical condition or hormonal change. Localized oestrogen therapy comes in the form of a vaginal ring, cream or tablet. This therapy benefits sexual function by improving vaginal tone and elasticity, increasing vaginal blood flow and enhancing lubrication.

Testosterone is also known to play a role in healthy sexual function, although women have much lower levels. Androgen therapy for sexual dysfunction is controversial, as some studies show a benefit for women who have low testosterone levels and other studies show little or no benefit.

Other medications include elective oestrogen receptor modulator, which helps reduce pain during sex for women with vulvovaginal atrophy. Originally developed as an antidepressant, Flibanserin is also approved by the FDA as a Treatment for low sexual desire in premenopausal women.

Opening up to each other is always the first step in understanding sexual needs in a relationship, as communication with the partner makes a world of difference in sexual satisfaction. Talking about your likes and dislikes, learning to do so and providing feedback in a nonthreatening way sets the stage for greater intimacy.

Other important point is being physically active can increase stamina and elevate mood, enhancing romantic feelings. Ultimately, when sexless couples facing obstacles in the bedroom put Dr G on the spot, he says that they should be good teachers to each other and ignite the art of love-making so the sexual dysfunction can fizzle away

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