Sexual Dysfunction

According to a study published in 1999 on Sexual Dysfunction in the United States (JAMA 1999;281:537-544), as many as 43% of all women in the U.S. experience some form of sexual dysfunction. Before we can even begin to look at the issue of sexual dysfunction potentially occurring as the direct result of a pelvic surgical procedure, we must first recognize that there is quite clearly a problem in this nation with female sexual function that desperately demands attention. The information gathered for this particular study used a national probability sample of 1749 women and 1410 men aged 18 to 59 years.

While the results written about in this study didn't identify prior surgical procedures that any of the women may have possibly undergone, it was still an astounding collection of data filled with valuable nuggets of information. Some key points:

• As a woman ages, sexual problems tend to decrease -- with the exception of those who report trouble with lubrication.
• Married women (and men) are associated with a decreased risk of experiencing sexual problems.
• Non-married women are 1½ times more likely to have climax problems and sexual anxiety.
• Women with college degrees report higher sexual desire, less problems achieving orgasm, less sexual pain, and less sexual anxiety than women who have not graduated from high school.
• Overall, women AND men with lower education levels report less pleasurable sexual experience and raised levels of sexual anxiety.
• Black women tend to have higher rates of low sexual desire and experience less pleasure compared to white women.
• White women are more likely to experience sexual pain than black women.
• Those who experience emotional or stress-related problems are more likely to experience sexual dysfunction.
• Lower household income puts women at higher risk for sexual dysfunction.
• Women with low sexual activity (less than 5 lifetime partners and limited masturbation) are at higher risk for low sexual desire and arousal disorders.
• Women reporting same-sex activity are not at higher risk than women with male partners.
• Arousal disorder appears to be highly associated in women who were sexual victims through adult-child contact or forced sexual contact.
• Sexual dysfunction is most common among young women.

In reading this study, the sheer numbers of women in this country not enjoying a healthy sex life free of sexual dysfunction nearly blew my socks off. But wait, this isn't the only study that's been done; others have estimated that up to 76% of women have complaints of sexual dysfunction which include: decreased libido, vaginal dryness, pain with intercourse, decreased genital sensation and difficulty/inability to achieve orgasm. Perhaps half of all women over the age of 40 have sexual complaints. Yikes! That's a lot of women.

In reviewing the sexual dysfunction studies that have been done on women who've undergone hysterectomy, something startling pops to the surface. Study after study shows sexual dysfunction for women both pre and post-hysterectomy at lower levels than the national population samples. Due to the impact of disease that often brings on depression, abnormal bleeding, pain and sexual discomfort, one would think that the number of women reporting some element of sexual dysfunction prior to hysterectomy would be HIGHER than the general population studies. Instead, hysterectomy studies all show levels of dysfunction for these women both before and after their hysterectomy as being LOWER than the general population. Clearly, something is wrong with either the general population studies or the hysterectomy and sexual functioning research.

Looking over the data collection methodologies for both types of studies, time and again the collection methods and questions asked of women in the hysterectomy studies were limited in scope and did not recognize or inquire about the full range of sexual dysfunction that potentially exists in the female population. If only four questions regarding sexual function are asked of women undergoing hysterectomy (as with the study recently published in JAMA), are their answers really going to provide a comprehensive picture of these women both before and after hysterectomy? Without a baseline reading of what sexual function was like for these women prior to the onset of disease, is pre and post hysterectomy data comparison and analysis truly relevant?

The flaws that exist in the hysterectomy and sexual function studies are abundant. Oftentimes, the research is handled by physicians or academicians who are NOT experts in female sexual function and who do NOT use validated questionnaires or relevant response point systems for their questions. Data analysis is typically incomplete and inconclusive and, as a result, I have a terrible time trying to understand the doctors who tell patients, "research shows that a hysterectomy has a positive impact on sexual function." This answer is frequently served up as a reassuring and definitive response to the question: "How will my sex life be impacted by a hysterectomy -- will it cause sexual dysfunction?" From my viewpoint, the research that would truly answer that question has simply not even been approached yet.

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This page last updated Saturday, February 02, 2002