Our understanding of the female sexual experience is constantly evolving, as we acquire new knowledge of the way in which the body works. In 1966, Masters and Johnson first proposed a model of sexual function for both men and women that consisted of 4 stages of “excitement” (arousal) with personal feelings of sexual pleasure accompanied by psychological and genital changes, “plateau” with maximal stage of arousal and muscular tension, “orgasm” with the peak of sexual pleasure and rhythmic contractions of the genital musculature and “resolution” with a general state of relaxation and well-being. By the mid-1970s, Kaplan modified the model proposed by Masters and Johnson and characterised the female sexual response cycle as a 3 phase model composed of “desire”, “arousal” and “orgasm”. The sexual response model continues to be revised and new models are tested.
Biological factors, including brain chemicals, are integral parts of sexual function and a balance between excitatory brain activity and inhibitory activity may be necessary for a healthy sexual response. Sex hormones (oestrogens, androgens and progesterone) also modify a woman’s motivation for or against sexual activity. The role of testosterone is best understood in this context; it plays a crucial role in sexual desire, arousal and receptivity towards sexual stimulation, and possibly orgasm.
Why is sexual wellbeing important for women?
The World Health Organisation wisely reminds us that “sexual health is a state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity”
- In a large population–based survey > 80% of women aged over 30 years agreed that an active sex life is important for one’s sense of well-being
- Higher levels of physical pleasure in sex are significantly associated with higher levels of emotional satisfaction
- Both men and women reporting a discrepancy between their own and their partner’s sexual desire have lower relationship satisfaction and individuals in sexually inactive marriages report less marital happiness
- Sex is not ‘just for the young’ - approximately 52% of 70 year old women report they are sexually active
- Women experiencing sexual health problems that concern them have diminished quality of life, similar to in magnitude to that seen in adults with other common chronic conditions such as diabetes and back pain.
The most commonly reported sexual problems in women relate to sexual desire and interest, pleasure, and overall satisfaction. Inability to achieve orgasm is also a common problem amongst women. Sexual problems are most common for women aged 45– 64 years (14.8%), lowest for women 65 years or older (8.9%), and intermediate in women aged 18 – 44 years (10.8%).
Factors associated with the development of sexual dysfunction in women include physiological factors (injury, surgery, hormonal disease), psychological disorders (depression, anxiety), and medications (antidepressants, anti-androgens and the oral contraceptive pill). Sexual problems have also been found to be more common in women who are middle aged, married, not partnered, less educated and postmenopausal especially surgically postmenopausal women. Other factors that have not been well researched but may underpin sexual difficulties include other illnesses such as diabetes, cardiovascular disease and major chronic physical illnesses, as well as chemotherapy and pelvic radiotherapy.
Women experiencing sexual function difficulties should speak to their doctor as female sexual dysfunction impacts adversely on self-esteem, quality of life, mood and relationships with sexual partners. It is associated with significantly lower health-related quality of life in women in general.