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What is female sexual dysfunction?

Female sexual dysfunction includes problems of sexual desire, arousal or orgasm. Sexual dysfunction also encompasses decreased sensation and pain during intercourse. Sexual dysfunction can lead to feelings of stress, embarrassment or inadequacy, and can affect your relationship with your partner.

Our approach

The gynecologists at Northwell Health always encourage an open discussion about sex. We help women with sexual dysfunction understand how things like aging, menopause, depression, medication and physical changes can affect your sexual function. Treatment is focused on restoring healthy sexual relationships and intimacy with your partner. We will also take the time to educate you on ways to ease sexual difficulties, helping you return to a state that will help you enjoy intimacy.

To treat sexual dysfunction, our urogynecologists specialize in:

  • Anatomic correction
  • Hormone management for vaginal lubrication
  • Estrogen and testosterone replacement
  • Arousal disorders
  • Orgasmic disorders
  • Vaginal muscle spasms (vaginismus)
  • Constricted vagina
  • Post-childbirth episiotomy pain
  • Pelvic floor disorders
  • Compatibility issues with partners

Our expert team takes time to offer counseling and the right referrals according to your specific situation. Northwell Health’s comprehensive approach addresses female sexual dysfunction all under one unit and has a robust set of nonsurgical and surgical interventions. The majority of patients improve without a surgical procedure.

Our team, which also includes dedicated nurse practitioners who are trained in sexual therapy, performs a detailed history and physical examination to identify the cause of the problem. When needed, laboratory testing is done to check for hormonal imbalance. Surgical correction of vulvar or vaginal abnormalities is available when necessary to help you experience sexual comfort. In addition, Northwell Health is one of only two centers in the nation specifically trained to perform Botox injections of the pelvic floor and vagina to help treat vaginismus, a condition consisting of involuntary spasms in the vaginal muscles.

The specialized care provided for women’s sexuality focuses on making you feel comfortable discussing sexual concerns and finding the best solution for your sexual dysfunction. Our doctors also collaborate with counselors who can help establish a stronger relationship between you and your partner.


Symptoms of female sexual dysfunction can include:

  • Low or nonexistent sex drive
  • Difficulty becoming or remaining aroused during sexual activity
  • Lack of orgasm
  • Pain during sexual activity

It is important to note that many factors can lead to sexual dysfunction, several of which are treatable. Certain medications, including antidepressants and blood pressure drugs, can inhibit the body’s sex drive and make it difficult to reach orgasm. Changing hormonal levels due to menopause may also impact a woman’s sensitivity to sexual touch and vaginal lubrication may become thinner or absent.

Risk factors

The following causes and risk factors are associated with female sexual dysfunction:

  • Estrogen deprivation from perimenopause or menopause
  • Anatomic problems related to size and/or comfort
  • Vaginismus
  • Psychological or emotional stress from fear of sex, or history of abuse causing an inability to relax and feel aroused. Specific problems include a lack of interest, arousal and/or orgasm.
  • Vaginal injury due to:
    • History of abuse
    • Vaginal delivery leading to an episiotomy or severe tearing
    • Previous vaginal surgery
    • Sporting events or other accidents
  • Loose vagina after trauma or childbirth
  • Medications
  • Psychological conditions


It will be important to discuss your sexual history with your doctor in order to determine the cause of your sexual dysfunction. A thorough sexual history includes reviewing medical, surgical, social, and psychiatric history. You may also be required to have a pelvic exam to check for physical abnormalities that can lead to pain and discomfort.


Treatments for sexual dysfunction depend on the underlying cause. Treatments typically include behavioral modifications, physical therapy, medications and counseling.

If you have vaginismus, you may choose to get vaginal dilation under anesthesia with Botox injections of the pelvic floor. You will first be injected with a local anesthetic and with Botox. The muscles that experience spasms are stretched and you will be gently dilated, typically from one centimeter in size up to an acceptable capacity of your partner's size. The procedure usually takes about half an hour. When you wake up, a dilator will be in a place that is an acceptable size for your condition. Over the course of a few weeks as you use the dilator, you will get used to penetration with a gradual transition. During this time, our nurses will work with you on both the emotional and physical component associated with the procedure, which does not require recovery time.

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