Female sexual dysfunction

According to the World Health Organization, sexual health as a state of physical, emotional, mental, and social well-being in the context of sexuality, excludes the mere absence of disease, dysfunction, or infirmity. Thus a woman’s sexual function encompasses many areas; the construct of a normal function as a quality of life indicator often but not always conforms to the sexual response cycle, which is an endogenous process contributed by hormonal, vascular, neuronal, and psycho-emotional factors. Clinical and scientific evidence abounds about the physiological role of sex steroids viz. oestrogen, testosterone, and also progesterone in facilitating and maintaining the woman’s sexual parameters. The neurophysiology extends from the central and peripheral nervous systems to the targeted genital structures resulting in coordinated vascular and non-vascular smooth muscle relaxation, to be accompanied by pelvic vasocongestion, vaginal lubrication, and labial and clitoral engorgement. Any detrimental impact on this normal cycle of concerted responses can result in a functional impairment or ‘female sexual dysfunction’ (FSD). Sexual changes, psychogenic or organic, are common in women at any age; such complaints are frequently accompanied by quality-of-life concerns, varying levels of personal distress, anxiety, depression, and also fertility concerns in younger women. With FSD as a medically diagnosable entity, fewer drugs have met the safety and efficacy criteria for global approval and clinical utility. In order to appreciate the diverse range of FSD and the extent of its physical, physiological, and psychological implications, it is important to understand the fundamentals as well as the changing paradigms in a woman’s sexual functioning.