There are many potential causes of sexual dysfunction in a woman. However, most can be broadly categorized as either physical or psychological, and sometimes a combination of both.

Physical reasons are often underlying medical conditions that can lead to female sexual dysfunction (FSD). Common examples include diabetes, heart disease, endometriosis and arthritis (inflammation of the joints). In addition, side effects from medications (prescription and nonprescription) may cause sexual dysfunction. These include:

• Antihistamines (allergy drugs)
  
  
• Oral contraceptives (birth control pills)
  
  
• Hormonal preparations
  
  
• Antihypertensives (blood pressure drugs)
  
  
• Cardiovascular medications
  
  
• GnRH agonists
  
  
• Chemotherapy drugs
  
  
• Medications for psychological disorders, such as:
  
  
• Antidepressants (e.g., selective serotonin reuptake inhibitors [SSRIs])
  
  
• Antipsychotics (schizophrenia drugs)
  
  
• Mood stabilizers (e.g., lithium)
  
  
• Drugs for anorexia nervosa
  
  
• Narcotics (prescription and illegal)

Certain hormonal changes related to pregnancy or menopause may also contribute to FSD. Other conditions that may cause difficulties include:

• Neurological disorders (e.g., multiple sclerosis)
  
  
• Pelvic surgery (e.g., hysterectomy, cancer surgery)
  
  
• Pelvic injury or trauma (e.g., rape and sexual assault)
  
  
• Urinary or bowel problems (e.g., incontinence)
  
  
• Endocrine disorders (e.g., thyroid, pituitary or adrenal gland problems)
  
  
• Alcoholism or drug abuse
  
  
• Smoking or other forms of tobacco use

Psychological reasons may be expressed as anxieties or fears that cause a woman difficulty with one or more of the aspects of sexual intimacy. Some of the more common triggers include:

• Anxiety, fatigue and stress from work or home life
• Worries about sexual performance
• Depression
• History of sexual trauma (e.g., rape, incest)
• An unresolved sexual orientation

Psychological factors also can have a tremendous impact on the sexual function of patients who have experienced gynecologic cancers. Fears of recurrence, an altered self-image and the after-effects of treatment can affect daily activities, careers and relationships.

Following a diagnosis of cancer or chronic disease, it is normal for a woman to experience anxieties regarding survival, family, finances, career and changes in body image and activity levels. All of these factors can lead to the strain a woman feels in expressing her sexuality and concerns about sexual desirability. If depression continues, the patient’s physician may recommend medications to help restore an interest in sex.

Painful intercourse (dyspareunia) is a common problem that is associated with hormonal changes, often related to pregnancy, menopause or female cancers. These hormonal changes can lead to vaginal dryness or vaginal atrophy, in which the shape and flexibility of the vagina gradually decline.