A sexual problem is anything that interferes with a woman’s satisfaction with sexual activity. When this happens, it is often referred by health professionals as female sexual dysfunction (FSD).
To understand why sexual problems occur, it is important to understand the sexual response cycle. This cycle is the same in both men and women, although at different rates and, obviously, with different physical changes.
Sexual response cycle: The cycle has 4 steps.
1. Desire (excitement phase) – Desire is a sexual “charge” that increases interest in and responsiveness to sexual activity. You feel “in the mood.” Your heartbeat and breathing quicken, and your skin becomes reddened (flushes).
2. Arousal (plateau phase) – Sexual stimulation–touch, vision, hearing, taste, smell, or imagination–brings about further physical changes. Fluids are secreted within the vagina, moistening the vagina, labia, and vulva. These fluids provide lubrication for intercourse. The vagina expands, and the clitoris enlarges. The nipples become hardened or erect.
3. Orgasm (climax) – At the peak of arousal, the muscles surrounding the vagina contract rhythmically, causing a pleasurable sensation. This is often referred to as the sexual climax.
4. Resolution – The vagina, clitoris, and surrounding areas return to their unaroused states. You feel content, relaxed, and possibly sleepy.
Every woman progresses through the cycle at her own rate, which is normal for her. A sexual problem may occur if any of these stages does not occur.
A. Sexual problems
The types of sexual problems in women correspond to the stages of the sexual response cycle. Inability to achieve any of the stages can interfere with sexual satisfaction and thus create a problem. Any of these can be very distressing for a woman, because everyone deserves a satisfying sex life. They can be distressing for her partner, too, and can lead to problems in the relationship.
Lack of sexual desire: – Lack of interest in sex, or desire for sex, is a common problem in both men and women, but especially in women. Lack of desire stops the sexual response cycle before it starts. Lack of desire is temporary in some people and an ongoing problem in others.
Difficulties becoming sexually aroused or achieving orgasm: – Inability to become sexually aroused is sometimes related to lack of desire. In other cases, the woman feels sexual desire but cannot become aroused. Orgasm may be delayed or does not occur at all (anorgasmia). This can be very distressing for a woman who feels desire and becomes aroused. It can create a vicious cycle in which the woman loses interest in sex because she does not have an orgasm.
Pain during intercourse: – Pain during intercourse (dyspareunia) is not uncommon. Like other sexual problems, it can cause a woman to lose interest in sex. A number of conditions may cause pain and / or discomfort during sexual intercourse. These conditions include:
1. Vaginal Infection: Certain vaginal infections such as vaginal yeast infections and trichomoniasis are often present without noticeable symptoms. However during sexual intercourse, the rubbing motion of the penis against the vagina and genitalia sometimes causes the symptoms of these vaginal infections to intensify causing stinging and burning. Genital herpes sores are another frequent cause of pain during sex.
2. Vaginal Irritation: Many products contain irritants which can cause vaginal irritation leading to discomfort or pain during vaginal sexual intercourse. These include: Any contraceptive foams, creams, or jellies, Allergic reactions to condoms, diaphragms, or latex gloves, Vaginal deodorant sprays, Scented tampons, Deodorant soaps, Laundry detergents in sensitive individuals, Excessive vaginal douching
3. Vaginal Dryness: Vaginal dryness often causes painful sexual intercourse. Normal vaginal lubrication is present for most women; however, during certain times the vagina may be dry and make vaginal penetration painful.
4. Vaginal Tightness: Occasionally this happens when you feel tense, or are not fully relaxed when penetration occurs. Difficulty in penetrating a tight vagina can happen even when vaginal lubrication is not a problem. Often, the first few times you engage in sexual intercourse, the vagina may be tight due to an unstretched hymen and cause pain at the time of penetration.

Sometimes a more severe condition called vaginismus is responsible for vaginal tightness; women with vaginismus experience strong, involuntary muscle spasms of the vaginal muscles during sexual intercourse or vaginal penetration by any object including fingers and tampons.
5. Pain of the Clitoris: The clitoris is the most sensitive part of the female genitalia. Gentle touching or rubbing of the clitoris is extremely pleasurable for some women, while for others it is unbearably painful. Clitoral pain may also occur due to poor hygiene; vaginal secretions may collect under the clitoral hood and if not carefully washed away may lead to pain.
6. Pelvic Pain: Occasionally a women will experience pelvic pain upon deep, thrusting penetration. Many conditions may cause this pain including:
• Tears in the ligaments that support the uterus (causes include problems during childbirth, inappropriately performed abortion, previous violent sexual intercourse or rape)
• Cervical, uterine, or tubal infections such as pelvic inflammatory disease (PID)
• Pelvic adhesions (often the result of previous pelvic surgery or PID)
• Endometriosis
• Ovarian cysts
• Uterine Fibroid Tumors
B. Psychological Factors
Impact of events during childhood and adolescence
Most studies that have assessed the impact of childhood experiences on female sexual dysfunction are methodologically flawed. They rely on retrospective recall, which is particularly problematic when emotional responses to the event as well as the actual occurrence of the event are being reported. However, there have been some probative links between childhood sexual abuse and having a later sexual dysfunction.
Relationship factors
A substantial body of research has explored the role of interpersonal factors in sexual dysfunction among women, particularly in relation to orgasmic response. These studies have largely focused on the impact of the quality of the relationship on the sexual functioning of the partners. Some studies have evaluated the role of specific relationship variables, whereas others have examined overall relationship satisfaction. Some studies have explored events; others have focused on attitudes as an empirical measure of relationship functioning. Subject populations have varied from distressed couples to sexually dysfunctional clients to those in satisfied relationships. Some major areas are relationship conflicts; extra-marital affairs; current physical, verbal or sexual abuse; sexual libido, desire or practices different from partner and poor sexual communication.
Individual factors
There has been little investigation of the impact of individual factors on sexual dysfunction in women. Such factors include stress, levels of fatigue, gender identity, health, extra marital relationship, financial, family or job problems, family illness or death, depression and other individual attributes and experiences that may alter sexual desire or response.
Physical factors
The female sexual dysfunction may occur due to physical factors have ranged from 30% to 40%. The disorders most likely to result in sexual dysfunction are those that lead to problems in circulatory or neurological function. These factors have been more extensively explored in men than in women. Physical etiologies such as neurological and cardiovascular illnesses have been directly implicated in both premature and retarded ejaculation as well as in erectile disorder, but the contribution of physiological factors to female sexual dysfunction is not so clear. However, recent literature does suggest that there may be an impairment in the arousal phase among diabetic women. Given that diabetic women show a significant variability in their response to this medical disorder, it is not surprising that the disease’s influence on arousal is also highly variable. In fact, the lack of a clear association between medical disorders and sexual functioning suggests that psychological factors play a significant part in the impact of these disorders on sexual functioning.
Other factors
• Changes related to menopause
• Communication problems with partner
• Damage to nerves due to surgery or trauma
• Fear of pain, infection, or being pregnant
• Feelings of guilt and shame about sex
• Lack of appropriate stimulation
• Lack of lubrication
• Medication
Medications
A. Medications that cause disorders of desire

Psychoactive medications
Antipsychotics
Barbiturates
Benzodiazepines
Selective serotonin reuptake inhibitors
Lithium
Tricyclic antidepressants

Cardiovascular and antihypertensive medications
Antilipid medications
Beta blockers
Clonidine (Catapres)
Digoxin
Spironolactone (Aldactone)

Hormonal preparations
Danazol (Danocrine)
GnRh agonists (e.g., Lupron, Synarel)
Oral contraceptives
Others
Histamine H2-receptor blockers and promotility agents
Indomethacin (Indocin)
Ketoconazole (Nizoral)
Phenytoin sodium (Dilantin)

B. Medications that cause disorders of arousal
Anticholinergics
Antihistamines
Antihypertensives
Psychoactive medications
Benzodiazepines
Selective serotonin reuptake inhibitors
Monoamine oxidase inhibitors
Tricyclic antidepressants
C. Medications that cause orgasmic dysfunction
Methyldopa (Aldomet)
Amphetamines and related anorexic drugs
Antipsychotics
Benzodiazepines
Selective serotonin reuptake inhibitors
Narcotics
Trazadone (Desyrel)
Tricyclic antidepressants

Diagnostic features
The DSM-IV (American Psychiatric Association) diagnostic criteria for female sexual arousal disorders are outlined here:
A. Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement.
B. The disturbance causes marked distress or interpersonal difficulty.
C. The sexual dysfunction is not better accounted for by another Axis I disorder (except another sexual dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Treatment
A. Provide education
Provide information and education (e.g., about normal anatomy, sexual function, normal changes of aging, pregnancy, and menopause). Provide booklets, encourage reading; discuss sexual issues when a medical condition is diagnosed, a new medication is started, and during pre- and postoperative periods; give permission for sexual experimentation.
B. Enhance stimulation and eliminate routine
Encourage use of erotic materials (videos, books); suggest masturbation to maximize familiarity with pleasurable sensations; encourage communication during sexual activity; recommend use of vibrators, discuss varying positions, times of day or placesetc.
C. Provide distraction techniques
Encourage erotic or nonerotic fantasy; recommend pelvic muscle contraction and relaxation (similar to Kegel’s exercise) exercise with intercourse; recommend use of background music, videos or television.
D. Encourage noncoital behaviors
Recommend sensual massage, sensate-focus exercises (sensual massage with no involvement of sexual areas, where one partner provides the massage and the receiving partner provides feedback as to what feels good; aimed to promote comfort and communication between partners, oral or noncoital stimulation, with or without orgasm.
E. Minimize dyspareunia
Treat the causes of dyspareunia. Ask the patient to use jelly in case of vaginal dryness.

Homeopathic Medication
Dyspareunia : Arg. Nit, Sepia, Nat. mur, Lyss, Platina, Calc phos, Thuja, Acid nit.
Vaginismus : Cact, Plb, Bell, Canth, Puls, Silicia, Lyco, Nat mur, Ignatia, Ferrum.
Aversion to sex: Asar, Caust, Nat mur, Sepia
Anorgasmia : Berberis, Caust, Phos, Ferrum, Sepia
Diminished sexual desire : Caust, Nat mur, Ferrum, Sepia, Acid phos, Graph, Lyco
Dryness of vagina : Nat mur, sepia, Graph, Lycop, Ferrum

Dr. SUNEETH MATHEW BHMS, M.Sc(Psy), M.Phil(Clinical Psy), PG Dip in Criminology & Forensic Science.
Reader, Dept of Practice of Medicine, Hahnemann Homeopathic Medical College, Rasipuram, Salem.
Consultant, Dept of Psychosexual medicine, V-Care Multispecialty Homeopathy, Coimbatore, Baluserry, Mananthavadi and Ideal Speciality Institute, Perambra.
Cell: 09486382600 URL: www.holykings.info