Why should I seek help?
Is it my fault?
What anatomy is involved?
What is healthy sexual function?
How do I know when to seek help?
Where do I go for help?
What can I expect when seeking help?
How do I seek help?
What self-help options do I have?
How do I seek help for female sexual dysfunction?
Even though your family physician or general practitioner is not a specialist, they can refer you to specialists. Getting the right treatment or referral depends on what your doctor knows about your symptoms, female sexual dysfunctions (FSDs), and the treatments/referrals available. Let’s take a look at how you can maximize your time and improve communication with your providers.
How do I prepare for my appointment?
Ideally, you will have read all of this web-based guide before seeking help. However, if you are crunched for time (or energy), make sure to read the following (listed in order of importance):
- What is healthy sexual function? and When should I seek help? so that you know exactly why you are seeking help and you can communicate it clearly and efficiently to your healthcare provider.
- What anatomy is involved in female sexual pleasure? so that you can identify the physical locations of your problems and communicate clearly with your healthcare provider. This will also help you be taken seriously.
- Where do I go for help? and What are possible referral options? to help you identify which healthcare providers might be right for you
- Treatment options so you have some idea of what the possible treatments are and you can ask about these treatments or referrals if your healthcare provider does not offer one that seems appropriate to you.
- Consider trying some of the self-help activities in advance (e.g., masturbation, vibrators, and adding clitoral stimulation to vaginal intercourse), as they may be suggested by more than one healthcare provider, and this will give you and your healthcare provider important information right away.
In Dr. Jen Gunter’s book The Vagina Bible, there is a chapter called “Communicating with Your Provider” with a section called “How to Think About Your Symptoms.” In this section, Dr. Gunter shares excellent information from a gynecologist’s perspective about how to seek help for female genital concerns. I will summarize Dr. Gunter’s advice and combine it with my own recommendations for FSD.
- Figure out what symptom(s) are bothering you the most, such as:
- sandpaper-like feeling
- pain with sex
- low desire
- can’t orgasm
- limited pleasure
- Identify where you are experiencing symptoms: in the vagina, on the vestibule, on the vulva, in your brain. Get more specific if you can by looking at What anatomy is involved in female sexual pleasure? (e.g., deep vagina, clitoris, left vestibule). You can also print a diagram of a vulva (from What genital anatomy is on the outside?) and mark the image where you feel your symptoms.
- Be precise about how long you have been bothered by these symptoms, how often they occur, and how long they last. “A while” is vague, but “six months” is clear. Take note of whether your symptoms started after a specific event (e.g., hitting your groin on a bicycle bar, stopping a medication) or if you have always had these symptoms (e.g., has sex ever been pleasurable?).
- Consider whether these symptoms happen in certain situations and not other situations (e.g., only with a partner, only with a certain partner, only with vaginal intercourse but not with cunnilingus).
- Write all of this down or say it out loud so it sounds correct. Writing it down is a good idea because (a) you will clarify your thoughts, (b) you can hand your provider your writing if you do not feel comfortable saying it out loud, and (c) you won’t forget important details.
Example: “Vaginal intercourse has become painful and I am very bothered by it. The pain started about six years ago but I just assumed it would go away. I only experience the pain with vaginal intercourse, not with any other type of sex, and it is worse when my partner is penetrating me from behind. It hurts in my vagina but I am not sure where—possibly deeper.”
What should I bring to my appointment?
If you are concerned that your healthcare provider may not be very familiar with FSDs or with your particular concerns, feel free to bring some resources along with you to help explain your concern or support your request for a specific test, treatment, or referral. In addition to the information in this guide, below are some of the resources that may be helpful. Unless I have noted otherwise, you probably won’t be able to access the articles directly. If you can’t access an article, you can access it via a university (or a friend who has university access) or you can just bring the webpage on When should I seek help?
If you are seeking help for a lesser-known condition (such as PGAD/GPD, PSSD, or FOIS), you should read about the condition a bit and bring in some peer-reviewed journal articles on the condition. Some doctors will be happy to read these resources and others may be dismissive. If you get a dismissive doctor, find a new one.
What are possible treatment options? and specific professionals you could see are also a great resource to bring along in case your healthcare provider is not familiar with FSD diagnosis or treatment.
Resources on desire disorders
Hypoactive sexual desire disorder (HSDD)
- “Toward a more evidence-based nosology and nomenclature for female sexual dysfunctions—Part II” by Parish et al. (2016) in The Journal of Sexual Medicine. https://doi.org/10.1016/j.jsxm.2016.09.020 (available for free at this link). The HSDD definition is on page 1893.
Resources on arousal disorders
Female genital arousal disorder (FGAD)
- “Toward a more evidence-based nosology and nomenclature for female sexual dysfunctions—Part II” by Parish et al. (2016) in The Journal of Sexual Medicine. https://doi.org/10.1016/j.jsxm.2016.09.020 (available for free at this link). The FGAD definition is on page 1895.
Female cognitive arousal disorder (FCAD)
- “Toward a more evidence-based nosology and nomenclature for female sexual dysfunctions—Part III” by Parish et al. (2019) in The Journal of Sexual Medicine. https://doi.org/10.1016/j.jsxm.2019.01.010. The FCAD definition is on pages 455–456.
Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD)
- “Persistent genital arousal disorder” by Jackowich et al. in the book Female Sexual Pain Disorders: Evaluation and Management (2nd ed.) by Andrew Goldstein.
- “Persistent genital arousal disorder: A review of its conceptualizations, potential origins, impact, and treatment” by Jackowich et al. (2016) in Sexual Medicine Reviews. https://doi.org/10.1016/j.sxmr.2016.06.003
- “Symptom characteristics and medical history of an online sample of women who experience symptoms of persistent genital arousal” by Jackowich et al. (2018) in Journal of Sex & Marital Therapy. https://doi.org/10.1080/0092623X.2017.1321598
- “Persistent genital arousal disorder: A special sense neuropathy” by Oaklander et al. (2020) in Pain Reports. https://doi.org/10.1097/PR9.0000000000000801 (Available for free at this link)
- This is a good resource if you are seeing a neurologist.
Resources on orgasm disorders
Female orgasm disorder (FOD)
- “Toward a more evidence-based nosology and nomenclature for female sexual dysfunctions—Part II” by Parish et al. in The Journal of Sexual Medicine. https://doi.org/10.1016/j.jsxm.2016.09.020 (available for free at this link). The definition of FOD is on page 1899.
Female orgasmic illness syndrome (FOIS)
- “Toward a more evidence-based nosology and nomenclature for female sexual dysfunctions—Part II” by Parish et al. in The Journal of Sexual Medicine. https://doi.org/10.1016/j.jsxm.2016.09.020 (available for free at this link). The definition of FOIS is on pages 1899–1900.
Resources on pain disorders
Vulvar pain caused by a specific disorder
- “2015 ISSVD, ISSWSH and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia” by Bornstein et al. (2016) in Obstetrics and Gynecology. https://doi.org/10.1097/AOG.0000000000001359 (available for free here). The newest definition of vulvar pain caused by a specific disorder is on page 747 in Table 3.
- “2015 ISSVD, ISSWSH and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia” by Bornstein et al. (2016) in Obstetrics and Gynecology. https://doi.org/10.1097/AOG.0000000000001359 (available for free here). The newest definition of vulvodynia is on page 747 in Table 3.
- “Definitions of sexual dysfunctions in women and men: A consensus statement from the Fourth International Consultation on Sexual Medicine 2015” by McCabe et al. (2016) in The Journal of Sexual Medicine. https://doi.org/10.1016/j.jsxm.2015.12.019 (available for free here). The definition of painful orgasm is on page 141.
Female genital-pelvic pain disorder (FGPPD)
- “Definitions of sexual dysfunctions in women and men: A consensus statement from the Fourth International Consultation on Sexual Medicine 2015” by McCabe et al. (2016) in The Journal of Sexual Medicine. https://doi.org/10.1016/j.jsxm.2015.12.019 (available for free here). The definition of FGPPD is on page 141.
It is important to note that pain with sexual activity may also be related to endometriosis, which can be difficult to get a diagnosis for. If you suspect you have endometriosis, educate yourself on this topic as well and check out the resources on endometriosis in this web-based guide.
Resources on medication-induced sexual dysfunctions
- “Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases” by Healy et al. (2018) in The International Journal of Risk & Safety in Medicine. https://doi.org/10.3233/JRS-180744 (available for free at this link)
- “Post-SSRI sexual dysfunction & other enduring sexual dysfunctions” by Healy (2018) in Epidemiology and Psychiatric Sciences. https://doi.org/10.1017/S2045796019000519 (available for free at this link)
- “Citizen petition: Sexual side effects of SSRIs and SNRIs” by Healy (2018) in The International Journal of Risk & Safety in Medicine. https://doi.org/10.3233/JRS-180745 (available for free at this link)
- “When antidepressants leave lasting damage: Living with post-SSRI/SNRI sexual dysfunction” by Grey (2020) in A Blog About Sex, Relationships, and Health. Available for free at https://www.sexlab.ca/blog/2020/10/17/when-antidepressants-leave-lasting-damage-living-with-post-ssrisnri-sexual-dysfunction
What do I do at the appointment?
Because your healthcare provider is human too (and faces barriers to providing you help), you may perceive their discomfort or hesitation with discussing sexual topics. As uncomfortable as it may be to start this discussion, many providers actually hope that patients will bring these concerns up themselves! That is why we are empowering you with information about how to do this.
- Ask your healthcare provider if you can make an audio recording of the appointment and explain why. You may receive a lot of information in the appointment and it is easy to forget or misremember the information. If you do not wish to record the meeting or if your healthcare provider does not give you permission, take written notes.
- Share the information you’ve prepared about your symptoms. You can read it, summarize it, or hand the written document to your healthcare provider. They should ask you some follow-up questions, even if you’ve prepared thoroughly.
- Don’t tell them what you think your diagnosis is until after you have shared and discussed your symptoms with them.
- Ask about treatment options and referrals. If your healthcare provider doesn’t have any suggestions, or if you are very keen on a specific referral or treatment option, you can ask about some of the treatment options and referrals you’ve read about in Where do I go for help?
- If your healthcare provider seems unfamiliar with FSDs or the specific sexual dysfunction you are wondering about, ask them if you can share information that you have selected from the materials recommended in What should I bring to my appointment? If you can, print out the articles yourself. Otherwise, you can share the website URLs and article titles.
- After sharing and discussing your symptoms with your healthcare provider, you should ask whichever follow-up questions are important to you. Keep in mind that not every question is relevant to everyone, that you will not have time to ask every question, that your healthcare provider may not know all of the answers, and that many of these questions may be more appropriate for later appointments or the specialists to whom you are referred. I have included some examples of follow-up questions that you may wish to ask below:
- Am I normal? Is this common?
- What do I do if I have more questions after my appointment?
- What do I do if things get worse/different between appointments?
- Can you recommend other resources, such as books, websites, support groups, or blogs?
- What can I do on my own to help?
- What can I do while waiting for diagnosis/treatment/recovery to regain a normal sex life?
Tests and diagnosis questions
- What else do you need to know?
- Do I have to show my genitals to anyone or let anyone touch my genitals?
- Will these tests be scary or painful?
- Are these tests covered by Alberta Health Care? If not, how much do these tests cost?
- Which test is the most effective, affordable, quick, or safe?
- What if I can’t afford this test? Are there less expensive options?
- What happens to test results? Who receives them? How do I find out what they are? Who will give me the results?
- Which specialists could I see?
- Do I call someone or will they call me? When will they call?
- What if I am uncomfortable with the healthcare provider I’m referred to? Is there another local specialist in this field?
- Is this curable?
- Have you treated someone with this condition before?
- How effective are these treatments?
- What are the risks of this treatment?
- Do I have to show my genitals to anyone or let anyone touch my genitals?
- Will these treatments be scary or painful?
- Are these treatments covered by Alberta Health Care? If not, how much do these treatments cost?
- What if I can’t afford this treatment? Are there less expensive options?
- What if I don’t want to do that particular treatment?
- What if these treatments don’t work?
- Which treatment is the most effective, affordable, quick, or safe?
- Will I have to get surgery?
- Can you explain the procedure to me?
- What should I or my partner watch out for with treatment?
- How long will treatment take? When will I feel better?
Medication-specific treatment questions
- Will I have to take medication?
- Will this treatment interact with other medications? Is it safe if I am pregnant, breastfeeding, or trying to conceive?
- What are the side effects of this medication?
- What are the risks of this medication?