Sexual dysfunction in women
- ICD–10: Insufficient experience of sexual pleasure F52.1
It is a fairly common dysfunction. It occurs in women of all ages. It can have the nature of a primary dysfunction, or a secondary (and selective) dysfunction. Often very simplistic descriptions of this dysfunction are limited to the peripheral component of sexual arousal. That is, the lack of vaginal lubrication, which makes coitus difficult.
Therapy consists primarily of psychotherapy and the effort to eliminate all disturbing factors. The biggest problem of selective frigidity is the openly or covertly conflicting relationship with the partner (husband). Among other influences, it is important to recognize larval depression and neurotic symptoms. In various psychopathological conditions, it is sometimes difficult to distinguish the effect of the underlying disease from the effect of psychotropic drugs.
Medicinally, it is possible to try to influence sexual excitement with dopamineergic preparations, yohimbine, or some antidepressants. Targeted psychotherapy consists in leading to a conflict-free experience of sexuality as a positive partner value.
- MKN–10: Nedostatečné prožívání sexuální slast Template:MKN
It is a fairly common dysfunction. It occurs in women of all ages. It can have a personalityprimary dysfunction, or dysfunction secondary (and selective). Often very simplistic descriptions of this dysfunction are limited to the peripheral component of sexual arousal. That is, to the lack of vaginal lubrication, which makes it difficult coitus.
Therapy consists primarily of psychotherapy and in an effort to eliminate all disturbing factors. The biggest problem of selective frigidity is the openly or covertly conflictual relationship with the partner (to the husband). Among the other influences, it is important to recognize the larval one depression and neurotic symptoms. In various psychopathological conditions, it is sometimes difficult to distinguish the effect of the underlying disease from the effect of psychotropic drugs.
It is possible to try to influence sexual excitement with medication dopamine ergic preparations, yohimbine, or some antidepressants. Targeted psychotherapy it consists in leading to a conflict-free experience of sexuality as a positive partner value.
- ICD–10: Dysfunctional orgasm F52.3
It is a well-known fact that women's [orgasm]] is much more vulnerable to various situational and external influences than men's orgasm. A woman is more demanding of her partner in her sexuality, she is more selective. It also becomes eroticized more slowly with age. It is not an exception for a woman to experience her first emotional climax after the age of 30, namely coital, non-coital orgasm, but also masturbation. Even after reaching the first orgasm, about a third of women have problems with this emotion. At least 8% of women, i.e. almost one in ten, remain without an orgasm throughout their lives. About a third of women have an orgasm sometimes, under certain conditions. Difficulty achieving orgasm, as well as anorgasmia, cannot therefore always be classified as sexual dysfunction.
Orgasm is primarily an emotion, i.e. a central function. However, its quality of experience is largely determined by peripheral manifestations, especially tonic and clonic contractions of the pelvic floor muscles. While central emotional experiences are difficult to train, pelvic muscle contractions can be strengthened with appropriate training.
psychotherapy has the main place here. Complete anorgasmia has a fundamentally worse prognosis. Incomplete anorgasmias have a better prognosis, when the woman admits to inducing an orgasm at least sometimes through masturbation, non-coital stimulation, or has experienced an orgasm in her dreams.
In the population, the idea of the usualness, even the obviousness of coital orgasm, even simultaneous coital orgasm, is deeply rooted. It must be realistically stated that such a simultaneous coital orgasm is not the rule at all. Therefore, we cannot put it as a norm to solve people's sexual problems. A large part of partner couples achieves a woman's orgasm practically only by non-coital stimulation and does not see anything unnatural about it.
There is an extensive international literature dealing with the issue of female arousal and female orgasm. It repeatedly shows an attempt to classify the female orgasm according to various characteristics. The most common is the classification according to the place from which the orgasm is induced. So, in the simplest case, orgasm is distinguished:
- uterine a
In our opinion, these classifications are only an expression of the higher variability of the female orgasm compared to the male orgasm. It will probably be most appropriate to differentiate women's orgasm mainly according to the intensity of the subjective experience into:
- "small" a
A small orgasm is not followed by a relaxation and refractory phase, a large orgasm has these attributes. It is not decisive from which place the orgasm is actually achieved.
Failure of genital response Template:MKN (isolated insufficient lubrication), or ``inorganic dyspareunia Template:MKN are conditions of recurrent or permanent discomfort, even pain during intercourse.
Speeches[edit | edit source]
Discomfort, pain, itching, burning are typically experienced. The area of occurrence is not only the vagina, but also the urethra and bladder. Conditions can appear during every intercourse or occasionally, during intercourse or after it, during the duration or only during deep penetration of the man's member, also only when using tampons, etc.
Division[edit | edit source]
According to etiology:
- Organic causes - urogenital atrophy, menstrual cycle complications, inflammation (vulvovaginitis, cystitis, PID), herpes genitalis, pudendal neuralgia, insufficient lubrication, endometriosis, anatomical abnormalities, injuries (pelvis, symphysis, bladder rupture), precancers, malignancies, consequence of oncological therapy, retroversion of the uterus, adhesions, leiomyomasy, lichen planus ', lichen sclerosus, Sjögren's syndrome, local allergic reaction, pelvic floor hypertonicity, etc.
- Functional causes - vertebrogenic problems, muscle imbalance, pelvic floor dysfunction, etc.
- Psychogenic causes - negative attitude towards a partner, sex, partner discord, negative experiences, trauma, rape, stressful situations, etc.
- Primary - arising during the first attempts at sexual intercourse (insufficient lubrication, careless immission, infection);
- Secondary - arising during sexual life (menopause, endometriosis, inflammation, surgery);
- Postpartum - even after a natural birth without complications.
- Superficial - skin pathology, vulvodynia, insufficient lubrication, vaginismus.
- Moderate - vaginal atrophy.
- Deep - pathology of the pelvic organs, endometriosis, infection of the pelvis and uterus, adhesions, cysts, fibroids, retroversion of the uterus.
Diagnostics and therapy[edit | edit source]
Diagnosis and therapy consists of the cooperation of a gynecologist, urologist, psychiatrist, sexologist and physiotherapist. In therapy, we try to eliminate the primary cause. In the symptomatic treatment of pain, we indicate artificial lubrication and local anesthetics. If necessary, the treatment should be supplemented by psychotherapy.
- ICD–10: 'Nonorganic vaginismus F52.5
Vaginismus is a sexual dysfunction characterized by strong and involuntary muscle contractions of the vaginal entrance during attempted penetration. Each dilation is significantly painful. A neurotic superstructure may also be present. The typical contractions of the vagina are sometimes accompanied by rejection reactions to attempted immiseration, up to reluctance and resistance to every touch on the genitals. In the vast majority of cases we observed, it was a primary disorder. Vaginismus is a frequent cause of an unconsummated marriage. It is interesting about such couples how long, often many years, they can live in a happy marriage, with regular but only non-coital sexual relations.
Therapy of vaginismus consists in the gradual and patient dilation of the mentioned vaginal spasms. Ideally, a properly managed couple will deal with the problem. After the initial dilation with the fingers, we usually put on a smaller vaginal vibrator.
Even achieving orgasm and a satisfactory course of sexual excitement does not necessarily mean complete satisfaction with the course of sexual life. Orgasm itself can be a source of very negative feelings. Although such conditions are extremely rare, we must draw attention to them. These include, for example, strong coital and orgasmic headaches of the migraine type'.
In women with stress-induced urinary incontinence, ``urination may occur during orgasmic contractions. Women can also experience copious orgasmic expulsions of urine during the so-called "female ejaculation".
Vaginal lubrication can also be so abundant that expelling it from the vagina makes the patient uneasy.
The field of ``psychopathology includes various described states of depression, exhaustion and weakness during sexual intercourse.
Treatment measures for such conditions must be strictly individualized. For coital migraines, ergoline derivatives, administered preventively, work well, for other vegetative symptoms, vegetative sedatives.
__ It is known that almost half of women experience a significant deterioration of mental state a few days before menstruation. This tension usually takes the form of a simple neurasthenic syndrome, but it can also take on serious psychopathological forms. With sex life this condition interferes especially when the deteriorated mood reduces sexual appetite and excitability. These disorders are often combined with partner conflicts, which naturally belong to the period of menstrual tension. In the premenstrual period, women have an increased risk of accidents, injuries, hospitalizations and the onset of incapacity for work.
Therapeutically, psychopharmaceuticals are used for premenstrual tension syndrome. Favorable experiences are reported with antidepressants of a number of selective serotonin reuptake inhibitors (SSRIs = selective serotonin reuptake inhibitor). An often successful measure is the administration of contraceptive tablets to suppress ovulation and induce artificial hormonal conditions. It is a clinical experience that women with an anovulatory cycle hardly suffer from premenstrual tension conditions.
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Author: doc. MUDr. Jaroslav Zvěřina, CSc. (Head of the Institute of Sexology 1. LF and VFN)