What defines female sexual dysfunction? Unlearning ‘failure’

What defines female sexual dysfunction- Unlearning 'failure' 1200400

Imagine you are asked to describe a healthy sex life. Chances are you will mention regular sex and a robust libido, along with frequent orgasms. You’d feel comfortable and free during sex and perform perfectly; unfettered by the pull and stresses of your daily life.

Now imagine you are asked to describe your own sex life. How will the scenarios compare?

Sex is a powerful and enigmatic part of women’s lives and identities. Beyond the doing itself, there are complicated ways we tie our sense of self to our sexuality, and often, standards which we hold ourselves to. These standards are what we think a successful sex life looks like.

When deviations — perceived or otherwise — from this idea are stamped with the official label ‘female sexual dysfunction’, it seems impossible to believe that there isn’t something wrong with us for not doing sex ‘right’. And the anxiety that stems from this is both misplaced and damaging.

Female sexual dysfunction is said to affect about one third of young and middle-aged women, plus about half of older women,[1] and is dubiously defined by the NHS as something that may include loss of desire or interest in sex, difficulties achieving orgasm, or feeling pain during sex.[2]

Against such vague criteria it’s hard to see where to draw the line for what’s ‘normal’. What, exactly, counts as female sexual dysfunction?

Even researchers aren’t quite sure. In 2000, a US study presented us with The Female Sexual Function Index, a six-domain framework including desire, arousal, lubrication, orgasm, satisfaction, and pain for measuring a woman’s sexual function. They note that a key barrier to clinical research in the area is the lack of well-defined outcomes, which makes it tricky to agree on ways to define sexual dysfunction.[3] In other words, there’s no clear answers because no-one is sure exactly what they’re looking for.

“I think to give someone that label is to give someone a diagnosis of an illness and it’s not an illness,” says GP and menopause expert Dr. Louise Newson, who runs a menopause clinic at Spire Parkway hospital in Solihull. “Dysfunction implies that you don’t function properly.” For there to be a dysfunction there needs to be an accepted norm of female sexual function for it to stray from, which has never been established.[4]

An essay in medical journal PLOS goes right out to accuse the pharmaceutical industry and other “agents of medicalisation” of disease mongering where it comes to female sexual dysfunction — of convincing people they are ill, or more ill than they are.[5]

What can be agreed on is that any difficulties or discomfort women experience in relation to sex can be brought on by a complex intersection of psychological, physical, and hormonal factors, explains Dr. Newson. And too often, women are neither informed enough to understand what they are feeling or know how to seek help. This is what likely contributes to the haze of confusion and embarrassment that hangs over the topic.

After having two of her children close together, Lyndsey Hiatt, 28, began to experience shooting pains up her vagina as if she was sitting upright on a stick. This lowered Lyndsey’s interest in sex, making her feel she had lost connection with her partner. “I was feeling like I had anxiety and depression,” she explains. While Lyndsey never received a formal diagnosis, by many accounts vaginal pain that interferes with sex and sexual desire qualifies as female sexual dysfunction.[6]

“I didn’t think it was anything,” she says. “I thought I would be able to get myself back to normal. I just couldn’t.”

Before opting for private laser surgery Lyndsey thought her vagina was abnormal, something she says is due to a complete lack of information and support out there for women in similar situations.

Dr. Newson too points to the lack of open dialogue and support for women as what’s holding back understanding of female sexual health. “Women wouldn’t bring it up voluntarily. They certainly wouldn’t talk to a doctor because they wouldn’t see that it’s a medical problem, and they wouldn’t know that there was something to be done that could help.” Social taboos surrounding female sexual health and pressures to perform sex a certain way could also have a negative effect on libido, she adds.

“It’s a real taboo over here. You can’t talk about orgasms, it’s all very uncomfortable; very British. And it makes something seem really abnormal when actually it’s not, because it’s not spoken about.”

Sadly, this is not a throwaway nod to British culture: women and girls in the UK are more likely to have poor sexual health than their European counterparts.[7] It’s also well-documented that many women struggle to speak about their sexual or reproductive health.[8]

Sometimes this is through no choice of their own. In a report by Maternity Action and the Women’s Health & Equality Consortium (WHEC), a woman wrote that “there are some GPs that are respectful and some that just love power and treat women like naughty children”, in response to a question about communicating with doctors.[9] Engaging medical professionals in topics of female sexual health is essential in changing the culture surrounding female sexual dysfunction, adds Dr. Newson.

All this silence and shame is doing nothing to promote understanding of female sexual health, or work to define useful ways to educate, diagnose, and help women.

It’s essential to take a step back and consider the implications of labelling people, Dr. Newson reminds us. Nothing any woman experiences in relation to her sexual health should be deemed a dysfunction, and we should be careful how we use the word normal where it comes to sex.

“What’s normal sexual practice?” she asks. “That’s what’s difficult. It’s not like you’re trying to get a normal blood pressure [reading] out of someone.” And if a patient told her they didn’t want to have sex ever again, she would never make them feel that they should. “It’s what’s normal for you and it’s what feels right,” she says.

As we can’t define female sexual dysfunction in a way that doesn’t force women into a normal versus dysfunctional binary, it shouldn’t be something they are identified against. It’s high time we unlearned the idea that sex is something it’s possible to succeed and fail at.

Page last updated June 2017

Monica Karpinski

Founder & Editor, The Femedic

Monica is the Founder and Editor of The Femedic. Against a journalism background and after years of leading content marketing projects in the healthcare space, it became clear that health information out there for women simply wasn’t good enough. No-one had bothered to look deeper into the ways women were searching for information, or consider the depth of what they actually needed to know. Instead of waiting for the perfect publication to approach her, she created The Femedic.

Monica has been named one of The Drum’s 50 under 30 for influential women in digital 2018 and was shortlisted for Female Entrepreneur of the Year in the 2018 British Business awards. She speaks and writes widely on gender and health inequality.

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  1. Sexual Advice Service Association, Women’s Sexual Problems, March 2015, published online http://sexualadviceassociation.co.uk/womens-sexual-problems/ (accessed May 17 2017)
  2. NHS Choices, Female Sexual Problems, Page last reviewed August 2016: http://www.nhs.uk/livewell/goodsex/pages/femalesexualdysfunction.aspx (accessed May 17 2017)
  3. Rosen, R. et al, The Female Sexual Function Index (FSFI): A Multidimensional Self-Report Instrument for the Assessment of Female Sexual Function, 2000, http://www.fsfiquestionnaire.org/Published%20Format.pdf (accessed May 17 2017)
  4. Harvard Medical School, What is female sexual dysfunction? June 2009, published online: http://www.health.harvard.edu/womens-sexual-health/what-is-female-sexual-dysfunction (accessed March 30 2017; page now archived but available as cache)
  5. Tiefer, Leonore, Female Sexual Dysfunction: A Case Study of Disease Mongering and Activist Resistance, PLOS Medicine, April 2006, published online: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030178 (accessed May 17 2017)
  6. Harvard Medical School, What is female sexual dysfunction? June 2009, published online: http://www.health.harvard.edu/womens-sexual-health/what-is-female-sexual-dysfunction (accessed March 30 2017; page now archived but available as cache)
  7. Women’s Health & Equality Consortium (WHEC), Why Women’s Health?, 2011, published online: http://www.whec.org.uk/wordpress/wp-content/uploads/downloads/2011/11/WhyWomensHealth11.pdf (accessed May 17 2017)
  8. Maternity Action & WHEC, Women’s voices on health: addressing barriers to accessing primary care, 2014, published online: http://www.maternityaction.org.uk/wp-content/uploads/2014/05/Access-to-Primary-Care-report-FINAL.pdf (accessed May 17 2017)
  9. Ibid.