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9.3: Etiology of Sexual Dysfunction

  • Page ID
    15621
  • i) FSD

    The etiology of FSD is multi dimensional including physiological and psychological factors, and interpersonal and sociocultural influences. (Table 1)
    Physiological factors, such as medical condition involving the urogenital tract, contribute to the complex etiology of FSD. Psychological factors such as mood disturbances, stress and substance abuse are also etiological factors. Interpersonal relationship such as partner illness or lack of privacy might also contribute to FSD. Finally, sociocultural influences, such as cultural and religious beliefs have an important impact on sexual function.

    Table \(\PageIndex{1}\): Etiology of female sexual dysfunction (FSD) (Bachman et al. In CD: Insights in FSD (2004)

    Physiol
    Psycol
    Urogenital
    Depression/Axiety
    Neural
    Prior Abuse
    CVS
    Stress
    Medication
    Alcohol/Substances
    Hormonal loss
    FSD
    Interpersonal Sociocultural Influences
    Inadequate education
    Conflict family, religious
    Societal taboos

    ii) FSD and urinary incontinence

    Urinary incontinence can be associated with FSD for a number of reasons, including physical and psychological factors, performance anxiety, pain and an unsympathetic reaction from the partner. Other issues contributing to a sense of reduced sexuality include a poor self-esteem, mood changes associated with decreased libido, the use of protective underwear and reduced spontaneity. The fear of leaking urine and a concern about odour also induce a sense of anxiety. Women who leak and have developed a vulval dermatitis as a result may occasionally present with Dyspareunia.

    Looking at the overall impact of stress, urge and mixed urinary incontinence, it would appear that a mixed picture has the most significant impact on sexual function in women.

    Coital incontinence should always be evaluated in the context of the women’s age since this has also been identified as an independent risk factor for a decline in sexual activity. Specifically, the menopause is known to be significantly associated with a decrease in libido, sexual activity and responsiveness. Caution should therefore always be exercised when evaluating a woman with FSD, where coital incontinence is occasionally blamed for sexual problems which pre-existed.

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