Female Sexual Dysfunction (FSD) has not been studied nearly as much as sexual dysfunction in males. Even less information exists on sexual dysfunction in women with mobility impairments. What does exist is four major categories of FSD developed in 2000 (find the full report here). Very briefly, these four categories are:
- Desire - women may have a decreased desire for sexual activity
- Arousal - women may have difficulty becoming aroused
- Orgasmic - women may have difficulty reaching orgasm
- Sexual Pain
Women may experience problems in one or more of these categories which can cause personal distress or interfere in relationships or social functioning. If you feel you have dysfunction in any of these areas, don't be afraid to talk to your doctor.
Women with Mobility Impairments
The most common barriers to sexual functioning reported by women with physical disabilities in CROWD’s national study were:
- Vaginal dryness
- Lack of balance
- Hip or knee pain
- Leg spasticity
Studies of women with spinal cord injury found bowel and bladder accidents, spasticity, positioning problems, and lack of spontaneity interfered the most with sexual activity with a partner. In our national study, sexual response was lowest in women with spinal cord injury and stroke.
In women with stroke and other brain injury (e.g., Traumatic Brain Injury, or TBI), sexual dysfunction depends on the severity of the neurologic impairment and the site of the damage to brain structures, but women with TBI in one study had more positive feelings about their sexuality than did men with TBI.
Extensive research has been done on physiology of sexual response in women with spinal cord injury and multiple sclerosis, but sex partners in surveys reported that emotional closeness and willingness to try a variety of sexual activities were more important for sexual fulfillment than physical ability.
- In SCI, ability for reflex lubrication, orgasm, and satisfaction depend on the completeness and level of injury.
- Psychogenic response, or sexual response that begins in the mind without physical touch, may still be possible with some incomplete injuries, and non-genital body parts often play a greater role in activating sexual response.
- Skin can become hypersensitive in spinal cord injury, making touch painful; conversely, increased sensitivity of body parts above the level of injury can increase sexual response.
- Participation in sexual activity was found to be related more to activity before injury than to extent of injury.
- Women with disabilities report being more upset by bladder accidents than their partners.
- There may be differences in sources of sex partners for men and women with spinal cord injury; nurses and other health professionals as a source of sex partners was not used at all by women in one study.
- Neurologic changes related to multiple sclerosis (MS) such as decreased desire, changes in genital sensation, decreased vaginal lubrication, and decreased frequency or intensity of orgasm directly affect sexual functioning.
- Non-genital numbness, pain, burning, discomfort, weakness, spasm, fatigue, incoordination, medication side effects, and cognitive impairments can also impair sexual function in persons with MS.
Few studies have been done of sexual functioning in women with progressive neuromuscular disorders, such as muscular dystrophy, spinal muscular atrophy, poliomyelitis or Charcot-Marie-Tooth disease.
- The neuromuscular disease process does not affect sexual response capability, sexual arousal, vaginal lubrication, or orgasmic capacity.
- The main factors affecting sexual practices and problems are age at onset of the neuromuscular disorder and its rate of progression, which imposes physical limitations.
- Nearly all men, but only one-third of women, report masturbating in surveys of sexual function of people with neuromuscular disorders.
- In a study of ventilator users with neuromuscular disorders, mainly polio, sex life was the only quality of life issue for which participants expressed dissatisfaction.
Arthritis and Other Connective Tissue Diseases
Factors that most commonly affect sexual functioning of women with arthritis and other connective tissue diseases include:
- Joint stiffness
- Loss of mobility
- Inadequate vaginal lubrication
- Pain is the most limiting symptom in most studies
- Loss of range of motion in the hips can interfere significantly with intercourse, and arthritis in the hands can interfere with masturbation alone or with a partner.
- Some women report worse arthritis symptoms the day after intercourse.
- Disabilities, such as scleroderma, and medications can produce acid reflux and heartburn that increases while lying down during sexual activity.
- Scleroderma can also tighten skin around the vaginal opening, and lupus can produce skin ulcers and rashes on the vaginal lining, making intercourse difficult.
Non-Physical Factors Related to FSD in Women with Mobility Impairments
Studies also indicate that non-physical factors can affect sexual functioning in persons with mobility impairments. These include:
- Negative self-image or body image
- Feeling less sexually attractive
- Fear of rejection
- Worry about satisfying their partner
- Difficulty communicating with their partner
- Low sexual esteem
Medication and FSD
Some medications commonly used in women with mobility impairments have sexual dysfunction as a side effect. Specifically, some medications reduce sexual desire or arousal. If you are having problems with sexual dysfunction, ask your doctor to go over your medications with you to see if any have these side effects and, if so, what can be done to lessen the effect.
Findings From Couples
More than half of couples report mutual dissatisfaction with their sexual relationship, with dissatisfaction directly related to the degree of functional disability and with women reporting greater dissatisfaction than men. The partner's unfounded fear of hurting the woman with a disability is found to interfere with engaging in sexual activity across disabilities.