The World Health Organization defines sexual health as a state of physical, emotional, mental, and social wellbeing in relation to sexuality, and not merely the absence of disease, dysfunction, or infirmity. This highlights the inter-related nature of the physical, mental, and social dimensions of sexuality, and the complexity of managing females with sexual problems (WHO Defining sexual health Geneva, 2006). What is female sexual dysfunction (FSD)? It has been stated that it may be easier to define it by what it is not, rather than what it actually is (Gierhart Obstet Gynecol 2006;107:750–1). For example, if a woman is not distressed by a ‘low sex drive’, then most health professions would agree that she does not have sexual dysfunction; however, if she is distressed by it, most would accept that she needs professional help. A recent British survey of sexual attitudes and lifestyles revealed that problems with sexual response in females were common (51.2%), but self-reported distress was much less common (10.9%) (Mitchell et al. Lancet 2013;382:1817–29). This suggests that the prevalence of FSD is overestimated, and often is a variation of the norm. In addition, female sexuality is affected by numerous factors, including ageing, estrogen deficiency, medications, and our modern multitasking lifestyle! Turning normality into ‘disease’ is one of the factors that led some people to believe that FSD is an artificial concept driven by commercial interest. It has been suggested that it is a corporate-sponsored disease driven by pharmaceutical interest (Moynihan BMJ 2003;326:45–7). In addition, the attention focused on sexuality and sexual performance by the popular press has created an unrealistic and non-representative standard, so much so that women often feel inadequate and believe that they have a problem. The current societal values of goal-oriented measurement of success by acquisition conflate this perceived problem. This leads to women having greater expectations for themselves that are not in keeping with the norm. While recognising that there is a need to define what is ‘normal’ sexual function, and therefore dysfunction, there is no doubt that a considerable number of women are distressed by sexual problems. Importantly, low sexual function is associated with negative health outcomes, contributing to the burden on the healthcare system. What can health professionals do to help these women? We need to move away from approaches that feed into the concept of the overmedicalisation of FSD. There is a need for greater emphasis on sexual function in health policies. Researchers need to agree on a standard definition to obtain a more realistic and accurate prevalence in order to provide evidence-based care. The recognition of and training in managing sexual problems should be included in all training curriculae, so that enquiry about sexual health is included in all consultations. As sex is a biopsychosocial experience, multidisciplinary care is essential. Last, but not least, the basic value of sex education, especially focusing on the heterogeneity of normal sexual function should be emphasised. Female sexual dysfunction is a real and complex problem. Let's recognise this and deal with it. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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Apr 9, 2023
Kenneth G Rice + 2
Open Access