Inability to achieve orgasm and satisfaction
Reduced genital arousal and sensation
Vaginal dryness
Low sexual desire
Pain during intercourse
Excessive vaginal laxity
Hormones
“There is consistent evidence from placebo-controlled randomized clinical trials (RCTs) that testosterone therapy is more effective than placebo for the treatment of [sexual dysfunction] in postmenopausal women.”
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International Society for the Study of Women’s Sexual Health clinical practice guideline for the use of systemic testosterone for hypoactive sexual desire disorder in women, 2021
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"Symptoms [of genitourinary syndrome of menopause], which are typically progressive and unlikely to resolve spontaneously, may include, but are not limited to, vulvovaginal dryness, burning or irritation, dyspareunia (pain during intercourse), or urinary symptoms of urgency, dysuria or recurrent urinary tract infection. ... Effective treatments include moisturizers and lubricants, local hormonal therapy with estrogen or dehydroepiandrosterone, and oral selective estrogen receptor agonists.”
​Phillips, N. A., & Bachmann, G. A. (2021). The genitourinary syndrome of menopause. Menopause, 28(5), 579-588.
Platelet Rich Plasma Injections
“There were statistically high significant mean values of desire, arousal, lubrication, orgasm, and satisfaction after treatment with [PRP injections.] ... PRP is an effective treatment of female sexual dysfunction. It is a minimally invasive procedure with very low side effects.”
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Journal of Women’s Health Care, 2017
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What is female sexual dysfunction?
1) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision. Arlington, VA: American Psychiatric Association; 2022.
Female sexual dysfunction is an umbrella term encompassing a range of common disorders, Female Sexual Interest/Arousal Disorder (FSIAD), formerly known as hypoactive sexual desire, reduced subjective and/or physical genital arousal (e.g., poor sensation or lubrication), pain during intercourse, and inability to achieve orgasm and/or satisfaction.
Hypoactive sexual desire is now known as Female Sexual Interest/Arousal Disorder (FSIAD).
Inability to achieve orgasm or satisfaction is known as Female Orgasmic Disorder (FOD).
What is the most common manifestation of female sexual dysfunction?
The most common manifestation is low or absent sexual desire or Female Sexual Interest/Arousal Disorder (FSIAD).
The next most common is orgasmic impairment or Female Orgasmic Disorder (FOD).
1) Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112(5):970-978. 2) Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537-544.
What is Female Sexual Interest/Arousal Disorder (FSIAD)
1) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision. Arlington, VA: American Psychiatric Association; 2022.
FSIAD, formerly known as hypoactive sexual desire, is clinically defined as lack of or significantly reduced sexual interest or arousal as manifested by at least three of the following:
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Absent/reduced interest in sexual activity
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Absent/reduced sexual or erotic thoughts or fantasies
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No or reduced initiation of sexual activity and unreceptive to partner's attempts to initiate
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Absent/reduced sexual excitement or pleasure during sexual activity in all/almost all (75% to 100%) sexual encounters
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Absent/reduced sexual interest or arousal in response to any internal or external sexual or erotic cues (written, verbal, or visual)
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Absent/reduced genital or nongenital sensations during sexual activity in all/almost all (75% to 100%) sexual encounters
How common is FSIAD?
1) Laumann EO, Nicolosi A, Glasser DB, et al. Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res. 2005;17(1):39-57. 2) Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112(5):970-978.
Between 26% to 43% of women 40 to 80 years of age have decreased libido. A study involving over 31,000 US women found that 8.9% of women 18 to 44 years of age had low sexual desire to the extent that it was concerning to them. The same symptoms were found in 12.3% of those 45 to 64 years of age and 7.4% in women older than 65 years of age.
What is Female Orgasmic Disorder (FOD)?
Female Orgasmic Disorder (FOD) is clinically defined as experiencing markedly less intense orgasms or marked delay in, marked infrequency of, or absence of orgasm in all or almost all (75% to 100%) sexual activity.
1) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision. Arlington, VA: American Psychiatric Association; 2022.
How common is FOD?
The American Psychiatric Association reports the prevalence of female orgasmic problems from 8% to 72%, depending on severity, with approximately 10% of women never experiencing orgasm in their lifetime.
1) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision. Arlington, VA: American Psychiatric Association; 2022.
What causes FSIAD & FOD?
1) Rosen RC, Connor MK, Maserejian NN. The HSDD registry for women: a novel patient registry for women with generalized acquired hypoactive sexual desire disorder. J Sex Med. 2010;7(5):1747-1756.
The cause of Female Sexual Interest/Arousal Disorder (FSIAD)and Female Orgasmic Disorder (FOD) is usually a combination of medical, sociocultural, individual vulnerability, and relationship/partner factors.
In premenopausal women the cause is more likely from non-physiologic factors, such as stress, fatigue, dissatisfaction with physical appearance, and other sexual difficulties that contribute to decreased desire.
Peri and postmenopausal women are more likely to experience physiologic factors contributing to FSIAD and Female Orgasmic Disorder such as vaginal dryness, vaginal atrophy, and hormone imbalance, as well as disorders of the nerves and blood vessels such as diabetes and cardiovascular disease.
What treatments are available for FSIAD and FOD?
1) Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: a reappraisal. An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(10):3489-3510.
There are a handful of pharmaceutical interventions designed to address Female Sexual Interest/Arousal Disorder (FSIAD) and Female Orgasmic Disorder (FOD). Most of them work on serotonin or dopamine receptors in the brain to manage psychologic issues that contribute to decreased sexual interest and difficulty achieving orgasm.
In younger females, these pharmaceutical interventions can be quite effective as FSIAD and FOD tend to be the result of psychosocial factors for this demographic. Hormone replacement therapy (HRT) can also be helpful restoring and improving the libido.
For peri/postmenopausal women, it is usually more effective to address the underlying physiology that is responsible for FSIAD and FOD. Some effective treatments include hormone replacement therapy (HRT) and platelet rich plasma (PRP) injections (O-shot).
HRT works by increasing the libido (testosterone), building up the vaginal wall and restoring lubrication to the vaginal canal (estrogen and testosterone).
PRP injections help to rejuvenate the vagina and clitoris providing increased sensitivity, pleasure, orgasm, and lubrication.