What Is Female Sexual Dysfunction, Really?

The little blue pill that helps men get erections has become as recognizable as sliced bread, and even the name Viagra forms the core of countless jokes in our culture (how could you forget poor Jake Gyllenhaal in Love and Other Drugs?). Things are changing, though, and the concept of Viagra is no longer only being applied to men's sexual wellbeing. The Food and Drug Administration (FDA) approved Flibanserin on Tuesday — affectionately dubbed the Female Viagra — and the drug will subsequently made available to American women struggling with female sexual dysfunction in October.

Designed primarily for use by premenopausal women who suffer from Hypoactive Sexual Desire Disorder (HSDD), Flibanserin is supposed to work by stimulating hormones in the brain that are connected to sexual desire. However, it has been rejected twice previously by the FDA, and the listed side effects have caused many doctors to speak out against its approval. Users may experience nausea, dizziness, dry mouth, difficulty sleeping, and fatigue after taking the medication. Leonore Tiefer, associate professor of psychiatry at NYU School of Medicine, told Time magazine that the drug is far too dangerous to administer to women; in short, she said, "it's a disaster." On the other side of the coin, some activists and campaign groups complain how sexist it is that Flibanserin doesn't already exist, and they hope the pill will provide women with the same chance to improve their sex lives.

Before we can even make a decision about the effectiveness of this new pink tablet, it's useful to take a close look at what it's supposedly treating — female sexual dysfunction. Is it a real disorder? If so, what are the symptoms and how are they determined? Medical professionals identify it as an official disorder, but there is a lot about the condition that might come as a surprise. Here are the facts you need to know about the condition.

What Is Female Sexual Dysfunction?

Also known as Female Sexual Arousal Disorder (FSAD) or Candace Syndrome, female sexual dysfunction a disorder marked by the recurring inability to become sexually aroused or maintain such arousal throughout sexual activity. Those who suffer from this dysfunction often experience lack of sex drive, trouble having orgasms, and/or absence of sexual fantasies over an extended period of time.

The nature of this syndrome — and a diagnosis from a medical professional — depends on several different factors. It could be a lifelong disorder that a woman is born with and has simply endured her entire life. There's also the chance the symptoms only arise in certain contexts and situations; for example, trouble only occurs with one sexual partner and not another, or during menopause. If a physician is conducting an exam to determine whether a woman does, in fact, fall into this category, they must have access to the detailed patient history, as anything can be relevant, from confounding medical or gynecological issues to an overview of their social life.

The exact number of women in the United States who deal with sexual dysfunction isn't exactly agreed upon in the medical community. Even The Score, a women's health campaign that agitated for the approval of Flibanserin, claims that a whopping 43 percent of American women wrestle with this disorder; this information was gathered by a survey in 1994 simply asking whether the female was having any sort of "sexual problem" in their life. According to womendeserve.org, however, 1 in every 10 American women are affected by a "biological lack of desire" to have sex, a statistic that was publicly challenged by sexologist and professor Dr. Ellen Laan of the Kinsey Institute. She says there were no diagnostic tests done in order to determine whether biological causes actually existed. All these conflicting facts simply shed light on the fact that we need more physician education in this area.

Are There Different Types Of Female Sexual Dysfunction?

Female sexual dysfunction can be broken down into four main categories: desire, arousal, orgasm, and sexual pain. Decreased desire to have sex is often associated with premenopausal patients whose partners are doing their duty of properly stimulating them. According to Dr. Nancy A. Phillips of the Wellington School of Medicine, this particular form of the disorder is difficult to treat, as many lifestyle factors are at play. Urogenital atrophy is generally responsible for arousal issues — but don't worry, it's not as ominous as it sounds. It's just a change that happens in the vagina when menopause comes a-knockin', and estrogen replacement is often the best way to treat it.

Having difficulty orgasming sounds like the worst symptom of all, but there is some fun to be had if this is the umbrella you fall under. The most effective therapy, according to the American Academy of Family Physicians, is to fantasize and masturbate — for at least an hour at a time — in order to maximize stimulation and minimize inhibition. Unfortunately, sexual pain, officially called dyspareunia, can be a tough one to tackle. It might be related to past trauma or abuse, and the vagina involuntarily contracts during intercourse.

It's perfectly normal for women to see an overlap in these categories, meaning they suffer from more than one at the same time. In fact, one could inform another, weaving a vicious cycle of sexual dissatisfaction because only one them are being treated.

What Causes Female Sexual Dysfunction?

The Mayo Clinic Staff bluntly calls the female sexual response a "complex interaction" of sorts. There are multiple factors to consider, including but not limited to physiology, chronic conditions, lifestyle, romantic relationships, and emotional state. When even one of these are thrown into disarray, the consequences show up between the sheets. Preexisting medical conditions are often the primary culprit of low libido. Diabetes might prevent sexual stimulation, for example, and chronic ailments such as asthma and urinary incontinence can result in embarrassment, which leads to decrease in getting busy. Changes in prescription drugs can also put a sad cloud over what happens in the bedroom, as well as the approach of menopause.

What the dialogue about Flibanserin — however heated it has become — has taught us is that the root of women's unhappy sex lives isn't just physical: The original Viagra was actually tested on both men and women. Both genders experienced an increase in blood flow in their respective genitalia; however, the males were the ones who experienced more satisfaction in the bedroom because blood vessel dilation in that region of the body meant an erect penis. The women? Well, for them, increased blood flow just wasn't the same as increased desire. It turns out we simply need more than extra blood pumped to our vaginas to get us all hot and bothered.

The emotional health of a woman is often ignored when the discussion of sexual dysfunction arises. Any of the following could contribute to low desire to get down and dirty: a partner who doesn't communicate well, lack of foreplay, no imagination, and sexual boredom. Rowan Pelling explores this notion in her latest piece in the Daily Telegraph called "Female Viagra Misses the Point," and it's a piece worth reading.

How Is Female Sexual Dysfunction Treated?

As any other disease, there are multiple options for curing or aiding sexual dysfunction in women. There has never been an FDA-approved drug before, though. A pill called bremelanotide, which underwent testing in the early 2000s, was used to increase libido in females (and worked for 90 percent of its subjects). Its negative effects on blood pressure prevented it from ever being administered by the FDA, and researchers are preparing for another round of clinical trials to see if it will ever be a viable product.

Dr. Phillips lists a number of other treatment options, however, including counseling, couples therapy, and individual sexual exploration. How a physician decides to administer remedies is unique to each woman's symptoms, as well as her lifestyle. Washington D.C. based writer and performer Laura Zam recently wrote a piece for Alternet called "How I Cured My Sexual Dysfunction Without A Pill," which chronicled her struggle with Hyposexual Desire Disorder at age 46, and how she went about addressing the issue. She saw a hypnotist, a sacred sensualist, and brought some homework to the bedroom to explore with her partner. The results were tangible, and she claims she's glad she put in the work to learn about her body rather than solely rely on the boost of a pill.

It remains to be seen just how well Flibanserin works for the many women who will likely be lining up to take it.

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