Feature

Commentary: Female sexual dysfunction is a real but complex problem

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c5336 (Published 30 September 2010) Cite this as: BMJ 2010;341:c5336
  1. Sandy Goldbeck-Wood, associate specialist in psychosexual medicine1, specialty doctor in obstetrics and gynaecology2
  1. 1Camden and Islington Mental Health NHS Trust, London
  2. 2Ipswich Hospital Trust, Ipswich
  1. goldbeckwood{at}doctors.org.uk

When the desire for sex goes persistently missing, a few women may be untroubled but many become unhappy. Some are unhappy because they miss the pleasure, physical release, and emotional intimacy that sex can provide or because a lack of sex stands in the way of having children. Sometimes their unhappiness is social or relational: because they fear hurting, rejecting, frustrating, angering, and perhaps even losing their partner. Many endure sexual unhappiness for long periods alone, feeling too embarrassed, ashamed, unentitled, mistrustful, or hopeless to ask for help. It is difficult to speak to a strange doctor about such private distress; more difficult still given that many fear embarrassing their doctor.1 2

So women who consult doctors about sexual problems are those for whom the unhappiness has become so intractable, or is causing so many physical or relational problems, that they are forced into the open. Some present a sexual problem directly, others indirectly through secondary symptoms such as depression, recurrent vaginal discharge, or chronic pelvic pain.3

Faced with a woman in tears whose libido has disappeared and who is terrified of losing her partner, doctors can feel immense pressure to provide an immediate, effective solution. Given that most …

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