Female sexual dysfunction. Frigidity. Anorgasmia. Dyspareunia. Vaginismus Female sexual dysfunction

Female sexual dysfunction is a fairly common problem, which is mainly observed in adult patients who have experienced several pregnancies and childbirth.

At the initial stage of the disorder, sexopathologists note a decrease in sexual arousal and a weakening of orgasmic sensations. Further, there may be pain and discomfort during intercourse.

At further development pathology in women, the addition of psychotic factors is observed. This means that the patient begins to experience fear and emotional discomfort in close contact with men, seeks to avoid intimate contact. Thus, a complex complex disorder is being formed, which requires an individual approach for the correction and restoration of libido.

Risk factors

Sexual dysfunctions most often appear in people aged 30 to 55 under the influence of one or more negative factors. Among the circumstances that cause a decrease in sexual desire for a partner, it is worth noting:

• a constant decrease in the background mood and the occurrence of depressive conditions
• any functional disorders that cause a weakening of the immune defense and increased susceptibility to various viral and bacterial agents
• congenital pathologies of the reproductive system
• multiple births, frequent abortions or miscarriages
• non-compliance with the rules of hygiene and personal protection when entering into sexual contact
• lack of a permanent sexual partner, frequent conflicts and quarrels with a spouse
• chronic fatigue syndrome, nervous and physical strain, disruption of work and rest
• bad habits, including alcoholism and substance abuse, drug addiction and smoking
• uncontrolled intake of any potent pharmacological drugs (for example, muscle relaxants and antidepressants, painkillers)
• unhealthy unbalanced over or under nutrition, set excess weight or severe underweight, anorexia nervosa and bulimia
• hormonal imbalance against the background of obesity or diabetes mellitus, disorders of the adrenal cortex and thyroid gland, ovaries, pituitary and hypothalamus
• the onset of the menopause period, which is accompanied by a decrease in the emotional background and a bad mood, thinning and dryness of the walls of the vagina, deterioration of the hair and nails, the appearance of pronounced signs of aging
• use of certain combined oral contraceptives and hormone replacement therapy

Clinical picture of female sexual dysfunctions

Patients are characterized by long-term sexual pathologies. As a rule, ladies and couples who have been suffering from a decrease in libido for several years seek medical help.

The state of a woman is especially strongly influenced by the nature of interpersonal relationships with a partner, as well as the social status of the couple. Emotional outbursts and depressive symptoms can develop in women who are forced to hide their relationship from society. Many patients who note signs of frigidity take self-treatment measures.

Patients of different ages believe that a course of any antidepressants, painkillers and sedatives will help them cope with the disease and restore a normal level of sexual desire. In most cases, the uncontrolled use of medications entails negative consequences in the form of complications of sexual pathology.

Features of the treatment of female pathologies

So that a woman does not suffer from unwanted side effects drug, she should adhere to the treatment recommended by a certified gynecologist. Otherwise, the risk of developing incurable pathologies of the reproductive system and severe psychotic disorders increases.

Before prescribing treatment, a medical specialist conducts diagnostics to determine the state of sexual function. To build an effective corrective tactic, the physician finds out:

• level, frequency and persistence of sexual desire
• activity of vaginal lubrication during intimacy
• characteristics (strength, frequency, time to reach) orgasmic sensations, the presence of a sense of satisfaction
• the presence of physical and psychological discomfort, pain during intercourse
• the degree of intimacy with a sexual partner, the presence of a stable psychological connection and a common sexual life

medical professionals with great experience therapeutic activity, they prefer to prescribe complex restorative therapy, which includes:

• medical treatment. Patients are prescribed safe hormonal, sedative and tonic agents. The doctor selects substances to eliminate signs of somatic health disorders
• therapeutic gymnastics. Women perform simple exercises aimed at stimulating the intimate muscles, strengthening the muscles of the vagina and increasing the overall tone. Regular exercise can increase self-esteem, maintain a high emotional background and avoid signs of a depressive disorder.
• taking dietary supplements and natural herbal remedies based on chamomile and aloe, ginseng and St. John's wort, parsnip and hops, dubrovnik and nettle. Vitamin food supplements in the form of dried fruits (dried apricots and dates, raisins and prunes) mixed with a small amount of nuts and honey are of great benefit.
• observance of the optimal mode of work and rest, obligatory good sleep
• a healthy diet that includes elimination alcoholic beverages and harmful synthetic products. A woman should receive the necessary daily dose of calories, take care of the balance of vitamins and trace elements

Sexual dysfunction in women refers to a variety of libido disorders (hollow attraction), as well as disorders of arousal, orgasm, pain associated with sexual intercourse. These symptoms (one or more) cause discomfort in women, disrupt the quality of sexual life and the harmony of relationships with a sexual partner.

Attraction and arousal disorders

A disorder of libido and arousal can have several forms of manifestation: a decrease (oppression) of libido, aversion to sexual intercourse, impaired arousal, hypertrophied sexual desire.

1. Decrease in libido (oppressed sexual desire) is the result of an insufficient erotic attitude towards sex (lack of thoughts and fantasies associated with sexual relations). The reasons for reduced arousal can be: mental illness, endocrine pathology, sexual mismatch of partners, alcohol and drug abuse, fatigue, stress, depression, physical overstrain, pregnancy, aging of the body.
2. Aversion to sexual contact (sex) is a pronounced, regularly repeated aversion to sexual contact with a partner ( possible reasons: rape in the past, mental trauma, conflicts with a partner).
3. Violation of arousal - the inability to maintain sexual arousal. This can be manifested by the lack of normal vaginal hydration, discomfort during intercourse, a decrease in the sensitivity of the clitoris (causes of pathology: neurological and endocrine disorders, vascular disease, impaired relationships between partners, aging).
4. Hypertrophied sexual desire is most often due to an increase in the concentration of androgens in the blood of a woman (reasons: tumors of the adrenal glands, ovaries, brain, trauma, vascular lesions, epilepsy, schizophrenia, psychosis).

Orgasm disorders

Orgasm is the highest degree of pleasure from sexual intercourse.

Distinguish between primary and secondary violation of orgasm. The primary disorder of orgasm is its slowdown, provided that there is a normal previous phase of excitation. Secondary orgasm disorders are most often caused by a mismatch between the sexual constitutions of partners, drug addiction, alcoholism, postoperative trauma to the nerves of the perineum and small pelvis, aging, and spinal cord injury.

Anorgasmia is the complete absence of orgasm. May be due to lack of sexual experience, psychological factors, sexual trauma, abuse, lack of stimulation.

Pelvic pain (dyspareunia and vaginismus)

Pain in the genitals that occurs during sexual contact is called dyspareunia. They can be caused by infectious and inflammatory diseases of the genital organs, bladder, endometriosis, ovarian cysts, the presence of adhesions, injuries and anomalies in the development of the genital organs.

Vaginismus (colpospasm) is an involuntary spasm of the vagina that prevents the insertion of the penis into it. Vaginismus may have a psychogenic etiology (fear of intercourse), past painful intercourse, or rape.

Diagnosis of sexual dysfunction

The diagnosis of sexual dysfunction is based on the patient's complaints, as well as the results of clinical, laboratory and instrumental research methods ( gynecological examination, definition of a hormonal background).

Treatment

The model for treating sexual dysfunction in women requires a delicate approach, which is why a step-by-step treatment has been developed.

Initially, the doctor discusses sexual problems with the patient, then gives her information about her existing diseases and disorders, and also informs her about their impact on sexual life and sexual function. After that, sexual rehabilitation of the patient is carried out: the patient is provided with information about options sexual life, the patient is informed about the features of anatomy and physiology female body, improve erotic stimulation (watching videos, reading books with erotic content), masturbation. The patient is also taught distraction techniques (relaxing erotic fantasies, exercises with sexual contact).

Sexual dysfunction is the difficulty experienced by an individual or couple at any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. According to DSM-5, sexual dysfunction requires the presence of extreme distress and interpersonal tension for at least 6 months (with the exception of sexual dysfunction caused by substances or drugs). Sexual dysfunctions can have a profound effect on the perceived quality of a person's sexual life. The term "sexual disorder" can refer not only to physical sexual dysfunction, but also to paraphilia; this is sometimes referred to as sexual preference disorder. Careful analysis of sexual history and assessment of general health and other sexual problems (if any) are very important in diagnosing sexual dysfunction. Assessing anxiety, guilt, stress, and anxiety is an integral part of optimal management of sexual dysfunction. Many of the sexual dysfunctions are based on the human sexual response cycle proposed by William Masters and Virginia E. Johnson and later modified by Helena Singer Kaplan.

Categories

Sexual dysfunction disorders can be divided into four categories: sexual desire disorders, arousal disorders, orgasm disorders, and pain disorders.

Disorders of sexual desire

Sexual desire disorders, or decreased libido, are characterized by a permanent or temporary lack of sexual desire or libido for sexual activity or sexual fantasies. The condition ranges from a general lack of sexual desire to a lack of sexual desire for a current partner. The condition may begin after a period of normal sexual activity, or the person may have persistently low sexual desire. The causes of sexual dysfunction vary considerably, but include a possible decrease in the production of normal levels of estrogen in women or testosterone in men and women. Other causes may be aging, fatigue, pregnancy, medications (such as SSRIs), or psychiatric disorders such as depression and anxiety. Although a number of causes of low sexual desire are often cited, few of them have ever been the subject of empirical research.

Disorders of sexual arousal

Sexual arousal disorders were formerly known as frigidity in women and impotence in men, although these have now been replaced by less subjective terms. Impotence is now known as erectile dysfunction and frigidity has been replaced by a series of terms describing specific problems that can be broken down into four categories described in the Diagnostic and Statistical Manual of mental disorders American Psychiatric Association: lack of desire, lack of arousal, pain during intercourse, and lack of orgasm. For men and women, these conditions can manifest as an aversion to, and avoidance of, sexual contact with a partner. Men may experience a complete or partial inability to achieve or maintain an erection, or a lack of sexual arousal and pleasure during sexual activity. These disorders may have medical causes such as decreased blood flow or lack of vaginal lubrication. Chronic illness may also contribute to the disorder, and the nature of the relationship between partners may also play a role.

erectile dysfunction

Erectile dysfunction, or impotence, is a sexual dysfunction characterized by an inability to develop or maintain an erection in the penis. There are various underlying causes of this disorder, such as damage to the pelvic splanchnic nerves that prevents or delays erections, or diabetes as well as cardiovascular disease, which simply reduces blood flow to the tissues in the penis, many of which are medically reversible. The causes of erectile dysfunction can be psychological or physical. Psychological erectile dysfunction can often be cured with just about everything the patient believes; there can be a very strong placebo effect. Physical damage is a much more serious cause. One of the leading physical causes of ED is permanent or severe damage to the pelvic splanchnic nerves. These nerves are near the prostate, exit from the sacral plexus, and can be damaged during prostate and colorectal surgery. Diseases are also common causes of erectile dysfunction; especially in men. Diseases such as cardiovascular disease, multiple sclerosis, kidney failure, vascular disease, and spinal cord injury are the source of erectile dysfunction. Due to its nature, the topic of erectile dysfunction has long been tabooed and the subject of many urban legends. Folk remedies have long been used to treat erectile dysfunction, with some dating back to the 1930s. The introduction of arguably the first pharmacologically effective impotence drug, sildenafil (trade name Viagra), in the 1990s created a wave of public attention, driven in part by newspaper stories and powerful marketing. It is estimated that about 30 million people in the United States and 152 million men worldwide suffer from erectile dysfunction. However, social stigma, low levels of health literacy, and social taboos lead to reduced reporting, making it difficult to accurately determine disease prevalence. The Latin term coeundi impotentia simply describes the inability to insert the penis into the vagina. At present, this term has mostly been replaced by more precise terms.

premature ejaculation

Premature ejaculation - ejaculation before the moment when the partner reaches orgasm, or until a mutually satisfactory length of time during intercourse. There is no correct time for the duration of intercourse, but in general, premature ejaculation is believed to occur up to 2 minutes after penis insertion. To be diagnosed, the patient must have a chronic history of premature ejaculation, poor ejaculation control, and the problem must cause dissatisfaction as well as anxiety in the patient, partner, or both partners. Historically, sexual dysfunction has been attributed to psychological causes, however, according to new theories, premature ejaculation may have an underlying neurobiological cause that can lead to rapid ejaculation.

Orgasm disorders

Orgasmic disorders are persistent delays or absence of orgasm after the normal phase of sexual arousal in at least 75 percent of sexual encounters. The disorder may be of physical, psychological or pharmacological origin. Orgasm disorders are usually caused by SSRI antidepressants, as they can delay orgasm or eliminate it completely. A common physiological culprit for anorgasmia is menopause, in which one in three women report problems getting an orgasm during sexual stimulation after menopause.

Painful sexual disorders

Painful sexual disorders affect almost exclusively women, and are also known as dyspareunia (painful intercourse) or vaginismus (involuntary spasm of the muscles in the vaginal wall that prevents sexual intercourse). Dyspareunia can be caused by insufficient lubrication (vaginal dryness) in women. Poor lubrication can be the result of a lack of arousal and irritation, or it can be related to hormonal changes caused by menopause, pregnancy, or breastfeeding. Irritation from birth control creams and foams can also cause dryness. In addition, the reasons may be fear and anxiety. It is not yet clear what exactly causes vaginismus, but it is believed that past sexual trauma (such as rape) may play a role. Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience burning pain during sex, which may be related to skin problems in the vulva and vagina. The reason is unknown.

Post-orgasmic diseases

Post-orgasmic illnesses cause symptoms shortly after orgasm or ejaculation. Postcoital sadness is a feeling of longing and anxiety after intercourse that lasts up to two hours. Sexual headaches occur in the skull and neck during sexual activity, including masturbation or orgasm. In men, post-orgasmic distress syndrome causes severe muscle pain throughout the body and other symptoms immediately after ejaculation. Symptoms last up to a week. Some physicians believe that the prevalence of post-orgasmic malaise in the population may be higher than reported in scientific literature, and that many people who suffer from post-orgasmic illness are undiagnosed. Dhat syndrome, another pathological condition in men, is a culture-related syndrome that causes anxiety and dysphoric moods after sex.

Pelvic floor dysfunction

Pelvic floor dysfunction can be a major cause of sexual dysfunction in both women and men and is treatable with physical therapy.

Unusual sexual disorders in men

Erectile dysfunction as a result of vascular disease is usually observed only among older people who suffer from atherosclerosis. Vascular disease is common in diabetics, people with peripheral vascular disease, hypertension, and smokers. Every time the blood flow to the penis is interrupted, erectile dysfunction occurs. Hormone deficiency is relatively a rare cause erectile dysfunction. In men with testicular failure, as in Klinefelter's syndrome, or in patients who received radiation therapy, chemotherapy, or childhood exposure to the mumps virus, the testes may stop functioning and not produce testosterone. Other hormonal causes of erectile dysfunction include brain tumors, hyperthyroidism, hypothyroidism, or adrenal dysfunction. Structural abnormalities of the penis, such as Peyronie's disease, can make intercourse difficult. The disease is characterized by thick fibrous streaks in the penis that cause the penis to look deformed. Medicines are also a cause of erectile dysfunction. Persons who are taking medications to lower blood pressure, using antipsychotics, antidepressants, sedatives, drugs, antacids, or alcohol, may have problems with sexual function and loss of libido. Priapism is a painful erection that occurs over several hours in the absence of sexual stimulation. This condition develops when blood gets stuck in the penis and cannot flow. Left untreated, this condition can lead to severe scarring and permanent loss of erectile function. The disorder occurs in young men and children. Individuals with sickle cell anemia and those who misuse certain medications can often be victims of this disorder.

The reasons

There are many factors that can lead to sexual dysfunction. It can be the result of emotional or physical causes. Emotional factors include interpersonal or psychological problems that may result from depression, sexual fears or guilt, past sexual trauma, and sexual disorders, among others. Sexual dysfunction is especially common among people with anxiety disorders. Ordinary excitement can lead to erectile dysfunction in men without psychiatric problems, but clinically diagnosed disorders such as panic disorder usually cause abstinence from intercourse and premature ejaculation. Pain during intercourse is often a comorbid disorder along with anxiety disorders in women. Physical factors that can lead to sexual dysfunction include the use of various substances such as alcohol, nicotine, narcotics, stimulants, antihypertensives, antihistamines, and some psychotherapeutic drugs. For women, almost any physiological changes that affect the reproductive system, premenstrual syndrome, pregnancy and postpartum period, menopause - can have Negative influence on libido. Back injuries can also affect sexual performance, as can problems with an enlarged prostate, problems with the blood supply, or nerve damage (as with sexual dysfunction after a spinal cord injury). Diseases such as diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis can also affect sexual activity, as well as failure of various organs and systems (such as the heart and lungs), endocrine disorders (thyroid, pituitary, or adrenal glands), hormonal deficiencies (low levels of testosterone, other androgens, or estrogen), and some birth defects. Pelvic floor dysfunction is also a physical and underlying cause of many sexual dysfunctions. In the context of heterosexual relationships, one of the main reasons for the decline in sexual activity among these couples is male erectile dysfunction. Erectile dysfunction can greatly affect this partner, whose subjective body image can be greatly affected, and can also be a major source of low sexual desire in him. In older women, the vagina naturally shrinks and atrophies. If a woman does not participate in sexual activity on a regular basis (particularly with vaginal penetration) with her partner, and if she chooses to engage in penetrative intercourse, she is more likely to face the risk of pain or injury. This can turn into a vicious cycle that often leads to female sexual dysfunction. According to Emily Wentzel, American culture is a culture of youth, which has led to sexual dysfunction being seen as a "disease that needs treatment" rather than a natural part of the aging process. It is not customary in all cultures to seek medical attention for erectile dysfunction; for example, people living in Mexico often accept erectile dysfunction as a normal part of their sex life.

Female sexual dysfunction

There are several theories that consider female sexual dysfunction from a medical and psychological point of view. Three socio-psychological theories include: the self-perception theory, the overfalling hypothesis, and the insufficient justification hypothesis. Self-perception theory: People make attributions about their own views, feelings, and behaviors based on their observations of external behaviors and the circumstances in which those behaviors occur. Overjustification Hypothesis: When an extrinsic reward is given to a person for performing an activity that is inherently rewarding, the person's intrinsic motivation will decrease. Insufficient justification: based on the classical theory of cognitive dissonance (a mismatch between two cognitions or between cognition and behavior will create discomfort). This theory states that people will change one of their cognitive attitudes or their behavior in order to restore alignment and reduce stress. The importance of how a woman perceives her behavior should not be underestimated. Many women perceive sex as a chore rather than a pleasant experience, and they tend to consider themselves sexually inadequate, which in turn does not motivate them to participate in sexual activity. Several factors influence women's perception of their sex life. These may include: race, gender, ethnicity, education level, socioeconomic status, sexual orientation, financial resources, culture and religion. Cultural differences also influence how women think about menopause and its impact on health, self-esteem, and sexuality. The study found that African-American women are the most optimistic about menopausal life; European women are the most concerned about this issue, Asian women are the most trying to suppress the symptoms, and Spanish women are the most stoic about menopause. About a third of women have experienced sexual dysfunction, which can lead to a loss of confidence in a woman's sex life. As women have sexual problems, their sex life with their partners becomes burdensome and unpleasant, and eventually women may lose interest in sexual activity. There are different situations and some women find it difficult to get mentally turned on, however, some women have physical problems. There are several factors that influence female sexual dysfunction such as situational factors where women do not trust their sexual partners. In addition, the environment in which women have sex with their sexual partner is critical, as having sex in an overly public or, conversely, extremely deserted place can make women feel uncomfortable. Withdrawal from sexual activity due to bad mood or burden from work can also lead to sexual dysfunction in women. Another factor is physical factor which can be caused by aging. This is a change in the state of the body, which leads to difficulties with arousal.

Menopause

The female system of sexual responses is complex and even today is not fully understood. The most common female sexual dysfunction associated with menopause includes lack of desire and libido; they are predominantly related to hormonal physiology. In particular, a decrease in serum estrogen levels causes these changes in sexual function. Androgen depletion may also play a role, but this parameter is currently less clear. The hormonal changes that occur during the menopausal transition affect women's sexual response through several mechanisms, some more important than others.

Aging in women

Whether aging directly affects the sexual function of menopausal women is another area of ​​controversy. However, many studies, including the Hayes study and Dennerstein's critical review, have shown that aging has a powerful impact on sexual function and dysfunction in women, especially in areas such as desire, sexual interest, and orgasm frequency. In addition, Dennerstien and colleagues found that a major predictor of sexual response during menopause is premenopausal sexual functioning. This means that it is important to understand how physiological changes in men and women can affect their sexual desire. Despite the seemingly negative impact that menopause can have on sexuality and sexual function, sexual confidence can improve with age and menopausal status. In addition, the impact that relationship status can have on quality of life is often underestimated. Testosterone, along with its metabolite dihydrotestosterone, is extremely important for normal sexual functioning in both men and women. Dihydrotestosterone is the most abundant androgen in both men and women. Testosterone levels in women under the age of 60, on average, are about half of what they had at the age of 40. Although this decline is gradual for most women, women who have had a bilateral oophorectomy experience a sudden drop in testosterone levels; this is because the ovaries produce 40% of the circulating testosterone in the body. Sexual desire is associated with three separate components: arousal, beliefs and values, and motivation. Particularly in postmenopausal women, desire fades and is no longer the first step in a woman's sexual response.

List of violations

DSM

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders lists the following sexual disorders:

Hypolibidemia (see also asexuality, which is not classified as a disorder)

Sexual aversion disorder (avoidance of sex or lack of desire for intercourse)

Female sexual arousal disorder (lack of lubrication)

male erectile disorder

Female orgasmic disorder (see anorgasmia)

Male orgasmic disorder (see anorgasmia)

premature ejaculation

Dyspareunia

vaginismus

Additional sexual disorders listed in the DSM that are not sexual disorders include:

Paraphilia

PTSD due to childhood circumcision or sexual abuse

Other sexual problems

Sexual dissatisfaction (non-specific)

Lack of sexual desire

anorgasmia

Impotence

Venereal diseases

Delayed or no ejaculation despite adequate stimulation

Inability to control the timing of ejaculation

Inability to relax the vaginal muscles enough to allow sexual intercourse

Inadequate amount of vaginal lubrication before and during intercourse

Burning pain in the vulva or vagina on contact with these areas

Feeling unwell or confused about sexual orientation

Transsexuals and transgender people may have sexual problems before or after surgery.

Persistent problems with sexual arousal

sex addiction

Hypersexuality

All forms of female genital cutting

Post-orgasmic illnesses such as Dha syndrome, post-coital sadness, post-orgasmic distress syndrome, and sexual headache.

Treatment

Men

Decades ago, doctors believed that most cases of sexual dysfunction were related to psychological problems. While this may be true for a subset of people, the vast majority of cases have been identified as having a physical cause. If sexual dysfunction is thought to have a psychological component or cause, psychotherapy may help. Situational anxiety arises from an early bad incident or lack of experience. This anxiety often leads to the development of a fear of sexual activity and avoidance of sex. In turn, sex avoidance leads to a cycle of heightened anxiety and penile desensitization. In some cases, erectile dysfunction may be related to marital disharmony. In this situation, marriage counseling sessions are recommended. Lifestyle changes, such as stopping smoking, drug use, or alcohol abuse, can also help with some types of erectile dysfunction. Several oral medications such as Viagra, Cialis, and Levitra have become available to combat erectile dysfunction, becoming the first line of therapy. These drugs provide a simple, safe and effective solution for approximately 60% of men. Otherwise, medications may not work due to misdiagnosis or chronic history. Another type of treatment that is effective in about 85% of cases in men is called intracavernous pharmacotherapy and involves the administration of a vasodilator. medicinal product directly into the penis in order to stimulate an erection. This method has an increased risk of priapism when used in combination with other treatments and may also be associated with localized pain. When conservative treatments fail, are unsatisfactory treatment options, or are contraindicated for use, the patient may choose to insert a penile prosthesis or a male penile implant. Technological advances have made the insertion of penile prostheses a safe option for the treatment of erectile dysfunction, resulting in the highest patient and partner satisfaction of all available ED treatment options. Pelvic floor physical therapy has been shown to be effective tool for the treatment of men with sexual problems and pelvic pain.

Women

Although there are no approved pharmaceutical drugs for the treatment of female sexual disorders, some drugs are being reviewed for their effectiveness. The vacuum device is the only approved medical device for the treatment of arousal and orgasmic disorders. It is designed to increase blood flow to the clitoris and vulva. Women who experience pain during intercourse are often prescribed painkillers or desensitizing drugs. Others are prescribed lubricants and/or hormone therapy. Many patients with female sexual dysfunction often also see a counselor or therapist for psychosocial counseling.

Menopause

Estrogens are responsible for the content of collagen, elastic fibers and the vascular network of the urogenital tract. All of these are essential in maintaining vaginal structure and functional integrity; it is also important to maintain vaginal pH and moisture levels to help maintain lubrication and tissue protection. Prolonged estrogen deficiency leads to atrophy, fibrosis, as well as reduced blood flow in the urogenital tract, which causes menopausal symptoms such as vaginal dryness and pain associated with sexual activity and/or intercourse. It has been consistently shown that women with lower levels of sexual features have more low levels estradiol. Androgen therapy for hypolibidaemia (HSDD) has little benefit, but the safety of this method is not known. It is not approved as a treatment in the United States. This method is used more often in women who have had an oophorectomy or who are postmenopausal. However, like most treatments, this method is also controversial. One study found that after a 24-week study, women taking androgens had higher rates of sexual desire compared to the placebo group. As with all pharmacological agents, androgen use is associated with side effects which include hirutism, acne, erythrocytosis, increased high-density lipoprotein, cardiovascular risks, and endometrial hyperplasia in women without hysterectomy. Alternative treatments include topical estrogen creams and gels applied to the vulva or vagina to treat vaginal dryness and atrophy.

Clinical researches

At present, the original clinical research on sexual problems usually dates back to 1970, when Masters and Johnson's Human Sexual Inadequacy was published. This was the result of more than a decade of work by the Reproductive Biology Research Foundation in St. Louis, including 790 cases. Prior to Masters and Johnson, the clinical approach to sexual problems had much to do with the work of Freud. This approach was associated with psychopathology, and was somewhat pessimistic about the chances of helping a person with sexual dysfunction. Sexual problems were considered only symptoms of a deeper ailment, and the diagnostic approach was based on the patient's psychopathology. Few differences were recognized between difficulty in functioning and variation between abnormality and disease. Despite the work of psychotherapists such as Balint, sexual difficulties were roughly divided into frigidity or impotence, terms that acquired negative connotations too early in popular culture. The achievement of Human Sexual Inadequacy was to move away from the field of psychopathology and move closer to learning. Only if the problem does not respond to educational treatment will psychopathological problems be considered. In addition, the treatment was directed at couples, while before each of the partners was treated individually. Masters and Johnson showed that sex is a shared act. They believed that sexual intercourse is a key issue in sexual problems, and does not depend on the specifics of a particular problem. They also suggested co-therapy, the matching of therapists to clients, arguing that a single male therapist may not be able to fully understand women's difficulties. Masters and Johnson's main treatment program was an intensive two-week program to develop an effective sexual relationship. The program began with a discussion and then aimed at a sensory focus in pairs to share experiences. Based on experience, it was possible to identify specific difficulties and suggest specific treatment measures. In a limited number of cases involving only men (41), Masters and Johnson developed the use of a female surrogate. This approach was soon abandoned due to ethical, legal and other concerns. In defining the range of sexual problems, Masters and Johnson defined the boundary between dysfunction and deviance. Dysfunctions were defined as something transient and experienced by most people, dysfunctions were limited to male primary or secondary impotence, premature ejaculation, ejaculatory incompetence; female primary orgasmic dysfunction and situational orgasmic dysfunction; pain during intercourse (dyspareunia) and vaginismus. According to Masters and Johnson, sexual arousal and menopause are normal physiological processes that occur in all functionally healthy adults, but although these processes are autonomous, they can be inhibited. The Masters and Johnson Dysfunction Treatment Program has an 81.1% success rate. Despite the work of Masters and Johnson, this field of research in the US was quickly taken over by enthusiastic rather than systemic approaches.

FEMALE SEXUAL DYSFUNCTION IS DIVIDED INTO DISORDERS:

1) desires

2) activation

3) orgasmic and sexual pain disorders.

Etiological factors may include previous somatic and gynecological diseases and their treatment, as well as psychosocial problems.

The main task of the doctor is a thorough detailed and patient history taking, its examination, identification of causes and consequences, ensuring a complete understanding of the problem, comforting the patient and recommendations for treatment.

For a better assessment of the situation, indirect questions and filling out personal data help the doctor. The doctor must create an environment in which the patient could feel at ease and open up to revealing all his problems. The first thing the doctor needs to find out is the sexual orientation of the patient. Then the beginning, duration and situation in which sexual dysfunction is expressed. Does it happen with a certain partner? For example: in a patient complaining of a decrease in desire in sexual relations, the cause may be sexual dissatisfaction, i.e., orgasmic disorders.

Various diseases also a possible frequent source of direct or indirect sexual problems. For example: diabetes mellitus or vascular disease can affect adequate arousal. Cardiovascular disease associated with shortness of breath can limit sexual relationships. Diseases such as arthritis or urinary incontinence cause discomfort and difficulty during intercourse, thereby leading to dysfunction and reduced sexual activity. Gynecological conditions associated with a woman's reproductive life (puberty, pregnancy, menopause) are potential obstacles to a woman's sexual life. Therefore, each patient should be examined by a gynecologist to exclude gynecological pathology.

Frigidity- the sexual coldness of a woman. This is a condition in which a woman, even in the most favorable conditions, does not feel sexual attraction and arousal. Never feel unsatisfied. Sometimes such disturbances of desire are associated with boredom and routine in sexual relations. So, frigidity can be divided into: temporary and permanent, as well as primary and secondary.

Primary frigidity- observed in patients from the very beginning of sexual activity, when the woman is not sexually awakened.

Secondary frigidity- a state of sudden or gradual disappearance of libido in a woman, as a rule, when the cause or influencing factors are eliminated, libido is restored.

Retardation frigidity- delayed pubertal and psychosexual development, the attraction of such people stops at the erotic or platonic stages, the absence of orgasm is combined with satisfaction on an emotional level without an attraction to sexual intimacy.

anorgasmia- violations of orgasm or its absence, occurs more often than frigidity mainly in women, since the male orgasm is associated with the process of ejaculation. In some cases, anorgasmia can be combined with a decrease in sexual desire or its complete absence. Anorgasmic women experience sexual desire, but do not achieve orgasm and remain unsatisfied. This condition can be caused by both sexual inexperience and lack of arousal. For example: when a woman has never experienced an orgasm in her life or a psychological factor (“involuntary orgasm inhibition”) or a condition caused by a long-term chronic illness. Psychogenic factors: insufficient psycho-emotional preparation of a woman for sexual intercourse, rape or rough sexual intimacy (during defloration), fear of pregnancy. A poorly chosen position during sexual intercourse (especially with insufficient penis size) or interrupted sexual intercourse (for example: premature ejaculation in a man) can also cause disharmony between partners. Men often use a woman as a tool for their own satisfaction. But in many ways, the satisfaction of a woman during sexual intercourse depends on right action a man who usually sets the rhythm, posture and the very nature of sexual intercourse, often a man is so passionate about himself that he forgets about stimulating his partner's erogenous zones, as a result, she does not experience an orgasm.

With a long absence of orgasm, the sexual desire itself usually fades away. The frequency of occurrence of anorgasmia depends on the age and duration of regular sexual activity. For many women, the first orgasm occurs only after childbirth, and for most after 10-15 years of regular sexual activity. As a result, up to 90% of neuroses in women are associated with their sexual dissatisfaction. Lack of orgasm during intercourse is usually caused by factors such as anxiety, lack of emotional intimacy of partners, distrust, low self-esteem.

SO THERE IS:

Relative anorgasmia- in which the possibility of obtaining an orgasm is extremely rare.

Absolute anorgasmia- when an orgasm does not occur under any circumstances.

Primary anorgasmia- the phenomenon of the absence of orgasm at the beginning of a woman's sexual life.

Secondary anorgasmia- loss of orgasm after a certain period of normal sexual activity. It can be observed when changing sexual partners, or after a long period of abstinence.

According to the severity of anorgasmia, it happens: 1) a woman does not have an orgasm, but sexual intercourse is accompanied by pleasant sensations of arousal, the secret of the gonads is secreted; 2) sexual intercourse is indifferent, there are no pleasant sensations; 3) sexual intercourse is unpleasant, disgusting.

In the treatment of anorgasmia, the prognosis largely depends on the willingness of both partners to change the existing stereotype of sexual intimacy.

Dyspareunia- painful sexual intercourse (general name for sexual disorders in women). Genital pain before, during (in the process) or after intercourse. Most common causes may be associated with infections inflammatory processes, lack of vaginal hydration, anomalies in the development of the genital organs, damage or injury to the ligamentous apparatus of the uterus, as well as internal or external genital organs, conditions after gynecological operations. Contributing factors are the lack of love and trust in a partner, neurotic and somatic diseases. Such women rarely experience orgasm during sexual intercourse and most often remain unsatisfied, feeling irritated and negative about themselves and their partner. With long-term dyspareunia, there is a decrease or loss of the very interest in sexual intimacy.

POSSIBLE THREE TYPES OF PAIN APPEAR: 1) SURFACE; 2) VAGINAL; 3) DEEP.

Superficial dyspareunia- pain that occurs when trying to start sexual intercourse.

Vaginal dyspareunia- pain that occurs during friction during intercourse (lubrication problems and impaired arousal).

Deep dyspareunia- pain associated with prodding during intercourse (often caused by various diseases).

vaginismus- this is an involuntary (unconscious), convulsive contraction of the muscles surrounding the entrance to the vagina, when trying to have sexual intercourse. Involuntary vaginal reflex - a spasm of the smooth muscles of the outer third of the vagina can be caused both by an attempt to have sexual intercourse (the entry or approach of a penis to the vagina), and by an attempt to penetrate other objects, such as the fingers of a gynecologist or even a woman's own hands. Muscle contraction occurs, spasm makes sexual intercourse almost impossible, severe pain occurs, the partner cannot penetrate the vagina through such a compressed opening, and repeated attempts give an effect feedback pain and discomfort, the already existing conditioned reflex is strengthened (the woman's body tries to protect itself from painful effects, responding with even stronger muscle tension).

Consciously, it is very difficult for a woman to accept a spouse, she simply cannot control this process, and an excited man faces a “brick wall” that cannot be overcome. After the cessation of attempts to enter the object, the muscles return to normal tone. Therefore, women with these problems begin to doubt whether they even have an entrance to the vagina, because with spasms of the vaginal muscles, sex is incredibly difficult, it seems that there is no entrance to the vagina.

The PC muscle surrounds the entrance to the vagina and the anal region. This is a very powerful muscle group that plays a key role in reproductive system women, participates in the act of urination and defecation, as well as in sexual intercourse.

Vaginismus affects hundreds of women who are doomed to loneliness. Often the accompanying problems of such women are anxiety, isolation, tension, the appearance of disagreements in marriage.

Patients complain that they cannot have sex, sex is incredibly painful and virtually impossible, they feel that they have a small vagina and any attempt to push the penis into the vagina causes acute pain. Women suffering from vaginismus are sexual and sensitive, but do not have the opportunity to have an active full sexual life.

Factors contributing to the development of vaginismus are sexual abuse, pain during the first attempts to start sexual activity, strict religious upbringing in the family, sexual fears, psychological trauma in the past, and other reasons.

Primary vaginismus- occurs from the first attempts of sexual activity, a woman always experiences pain and discomfort during intercourse.

Secondary vaginismus- the woman had painless sexual intercourse in the past, vaginismus developed later, due to any reason.

Along with these disorders, there is also a hypersexual syndrome, as one of the forms of sexual disorders, this is a sharp increase in libido (increased libido). A group of people with an extremely strong sex drive, but who rarely get full sexual satisfaction despite an active sex life. So hypersexuality in women is designated by the term - nymphomania, and in men satyriasis.

SIGNS OF HYPERSEXUAL SYNDROME:

1) an insatiable need for sexual intimacy, violating everyday life 2) sexual life devoid of an emotional component 3) sexual intimacy does not bring satisfaction, despite the presence of an orgasm.

KEY STRATEGIES USED IN THE TREATMENT OF SEXUAL DYSFUNCTION:

It is very important that both partners acknowledge and understand that there is a problem. It requires the cooperation of both partners and the development of skills that allow you to come to an orgasm together.

1) Providing the patient with information (educational part). For example: about normal anatomy, sexual function, normal changes with aging, pregnancy, menopause.

2) Methods for increasing arousal and eliminating sexual routine: encouraging the use of erotic materials (videos, books), changing positions during sexual intercourse.

3) Methods of distraction: encouragement of erotic and non-erotic fantasy, recommendations for Kegel exercises (training of the pelvic muscles), the use of background music and/or video.

4) Solving the problem of sexual harmony by searching for erogenous zones (parts of the partner's body with an increased degree of sexual arousal).

5) Direct, including anatomical changes in the genital organs, providing maximum sexual stimulation (an increase in the G-spot in women, an increase in the size of the penis in men).

The pubococcygeus muscle is the main sexual muscle, its fibers start from the pubic bone, surround the entrance to the vagina and reach the coccyx. In some women, with age or after childbirth, the tone of this muscle can decrease significantly.

It is possible to feel the work of the pubococcygeus muscle during urination, if you try to arbitrarily stop urination. Then insert your finger into the vagina and repeat that effort. If the muscle tone is sufficient, then the vagina will gently wrap around the finger. Sitting in a comfortable position on the bed, try to practice tensing and relaxing this muscle, repeat this exercise 10 times in a row.

Every day, you need to gradually increase the load and bring the number of contractions up to 50 times. After that, you can try to complicate the exercise by first trying to strongly compress the muscle, then slowly relax it, making several stops, or quickly compress and quickly relax, accelerating the previous contractions. Having mastered these exercises, perform workouts unnoticed by others at any time convenient for you during the day. After the muscles are strong enough, it is necessary to keep them in good shape with daily workouts.

WAYS TO MINIMIZE DYSPAREUNIA:

1) Advice on using positions where the woman is on top and able to control the man's penetration. Or the use of such positions in which it is possible to minimize the occurrence of pain and deep penetration of a man.

2) Using warm baths before intercourse to increase arousal.

3) Use topically lubricants to reduce friction.

4) The use of drugs before sexual intercourse (non-steroidal anti-inflammatory drugs).

5) Use of local anesthetics.

Achieving maximum arousal and reducing psychological inhibitions (Kegel exercises, masturbation, distraction techniques, use of fantasy or music).

TREATMENT OF VAGINISM:

1) A clear understanding of the problem, identifying the causes and factors in the development of vaginismus.

2) The study of the anatomical structure of the genital organs and their role in sexual intercourse.

3) Learn to control the pubococcygeus muscle.

4) Use of a dilator.

Does impotence exist in women? After all, a woman cannot suffer from a weak erection. This is the widely held opinion on the matter. In reality, it looks a little different. Women may suffer from sexual impotence. Only female impotence is not discussed so publicly.

Impotence refers to loss of libido. However, women may also suffer from other problems that are directly related to active sexual relations in life. So, some women suffer from vaginal dryness. This leads to the fact that sex is very painful not only for a woman, but also for a man.

Causes must be addressed immediately and promptly. A woman needs to consult a doctor to prevent possible damage and pain. Many more women suffer from impotence than men. This has been proven in numerous studies. The essential difference is that most women can have sexual intercourse despite their lack of desire. What a man with an absent erection cannot do. Many women perceive this as a cross of fate and usually do not know that even female impotence can be treated quite successfully.

The causes of impotence can be both in the physical (bodily) area, as well as in the mental (mental). Often, both causes depend on each other. Imagine, your friend's girlfriend would be incapable of fertilization, and she adds to her physical problem also a mental complex.

Erectile dysfunction is considered one of the common diseases of civilization and is often considered as a purely male problem. But more and more women suffer from weak potency and the desire to have sex because they cannot achieve orgasm. Female impotence, in principle, is no different from male. They have the same causes and effects.

After the birth of a child, almost every second woman complains of a loss of libido after her body endured one or more children.

In a sense, this is explained biologically. The woman is fertile and has no children, the level of androgen hormones is quite high. These hormones provide a woman with sexual desire. When a woman has fulfilled her biological duty, if I can put it so subtly, then there is no more reason to continue to act sexually.

Some women have problems with insufficient potency, do not get enough sleep and rest, or are prone to high alcohol consumption and smoking too much. As with any deterioration in health, the rule applies - the sooner, the better the appeal to specialists.

Medicine is currently able to eliminate the symptoms of potency disorders. It is only necessary to start treatment at an early stage before irreversible consequences begin. If this does not last too long, it can be corrected with lifestyle changes and therapeutic rest. Potency, strength and sexual desire will be restored. Here are some of the main causes of impotence:

• chronic diseases such as arthritis;
• Fatigue;
• Neurological diseases like multiple sclerosis;
• Surgical treatment of the pelvic organs;
• Pelvic fracture, spinal cord injury;
• Diabetes mellitus, functioning of the thyroid gland;
• Antidepressants, chemotherapy drugs, etc.;
• Bad habits: alcohol, tobacco, etc.;
• Extreme obesity, which leads to mechanical disorders;
• Dyspareunia is pain during intercourse.

Sexual desire is present, but orgasm does not occur - this is called anorgasmia. Spasm of the vagina (vaginismus) can lead to a sharp narrowing of the vagina and the penetration of the penis is difficult.

The most common form of "female impotence" is frigidity. The term frigidity refers to a decrease in sexual desire, coldness, lack of orgasm. Physical reasons:

• Small vaginas and vulvas;
• Inflammation in the vaginal area;
• Pelvic inflammatory disease, etc.

Hormonal changes after menopause can cause changes in the tissues and genitals in women. Lack of lubrication and vaginal dryness can result from these hormonal changes. Psychological and situational causes:

• Religious orthodoxy;
• Depression, anxiety, fear, guilt, interpersonal problems in relationships between partners;
• Emotional stress for a long time;
• Difficulty getting an orgasm.

How to treat

A gynecological examination is necessary - pathologies should be excluded. Psychiatric examination of both partners is mandatory - it is necessary to assess the quality of your relationship.

Psychological counseling helps to understand both partners and each other's needs. For vaginal dryness, use a vaginal lubricant during intercourse. hormone therapy may help some women.

A healthy lifestyle will help you get rid of smoking, alcohol, etc.

Alternative therapies such as yoga and meditation are helpful in relieving stress. A more suitable position: the man lies on his back, the wife sits on him. This is a mentally and physically less problematic situation for a person. Additional help may be to move the time of intercourse to the morning. Also, the patience and understanding of partners in matters of mental hygiene is very important.

Older men lose their sexual energy gradually, but this does not only happen over the age of 60. Young men are increasingly suffering from sexual impotence. In women, this problem is often combined with a lack of desire to have sex, a decrease in sexual desire is a psychological aspect.

Good potency for women: Women's Viagra (Lovegra) is a popular drug that helps solve many problems.

Until now, it has been difficult to find a suitable potency for women on the market. Androxan Femme is a dietary supplement that can help give you more energy, vitality and performance, a natural aphrodisiac for increased libido.

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Scientists criticize the planned distribution of pills for women, following the example of Viagra. After the success of treating male potency, the pharmaceutical industry came up with the pill in hopes of better returns. Allegedly, female impotence is present in 43 percent of all women. Psychologists confirm that women can feel their inability to fantasy during intercourse, and when taking pills, they relax more. Many women do not get sexual pleasure. But this does not mean that you have a disease.

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Women's sexuality has its influence on our desires. Even if we do not realize it and do not guess. The emergence of sexual desire depends on a number of physical and psychological factors: lifestyle, hormones, fantasies, feelings and educational level.