Although, the manifestation of SD may vary, however, sexual problems are better defined when there are specific elicited signs or symptoms because many affected women may broadly describe the dysfunction to reduced libido or general dissatisfaction. Some women however are more specific, complaining of symptoms such as pain during sexual arousal or intercourse, anorgasmia (coughlan's syndrome), retarded orgasm, and reduced sexual arousal. Reduced vaginal lubrication may be common among postmenopausal women due to estrogen shortage and vaginal atrophy.Therefore, careful assessment including physical examination is important to identify the specific problem. 

Body examination may be done including the reproductive organ in order to evaluate or localize pain associated with vaginal penetration and overall sexual activity  [27]. Clinical examination of external genitalia to asses the skin color, texture, including the thickness is necessary. Also, features such as skin turgor, distribution and strands number of the pubic hair assist diagnosis. Internal mucosa and anatomy should then be examined and cultures taken if indicated. Specific vaginal structure such as muscle tone, incision site of episiotomy, tissue atrophy, as well as vaginal discharge. Bi-manual examination with the use of speculum for female patient with vaginismus (vaginism) and severe form of dyspareunia may be painful however, mono-manual evaluation using fingers could be better [26]. These techniques are also good in assessing the position or size of  uterus, cervical motion tenderness (CMT), vaginism and diagnosing rectal disease. Also, other conditions such as, vaginal internal muscle tone, depth, and size or position of the both ovarian and adnexal mass.

• Pain

  Chronic pelvic pain (CPP) in women and men is associated with significant sexual dysfunction. [ncbi.nlm.nih.gov]

  Sexual Pain Disorders Female sexual pain disorders include dyspareunia, vaginismus, vulvodynia, vestibulitis, and noncoital sexual pain disorder. [web.archive.org]

• Infertility

  RESULTS: Proportion of females with sexual dysfunction was higher in the infertile versus control group (47% versus 30%, 95%CI for the difference: 8%, 26%, p-value: CONCLUSION: sexual dysfunction is more prevalent in infertile versus control group. [ncbi.nlm.nih.gov]

  PID may result in chronic pelvic pain, infertility, ectopic pregnancy, and abscess formation. [beyondbasicsphysicaltherapy.com]

  For other women, sexual dysfunction can also result from life stressors such as marital conflict, infertility issues, childbirth or an overly busy lifestyle. [hoag.org]

• Weakness

  However, patients may experience some degree of malnutrition, which may lead to various clinical symptoms, such as fatigue and weakness. [ncbi.nlm.nih.gov]

  […] of POIS. [1] [3] Symptoms may develop within seconds, minutes, or hours after orgasm, and usually last for 2 to 7 days before going away on their own. [1] [3] [4] Possible symptoms vary from person to person, but more common symptoms include fatigue, weakness [rarediseases.info.nih.gov]

  Symptoms include genital numbness, decreased sex drive (libido), erectile dysfunction, failure to become aroused or orgasm, pleasureless or weak orgasm, and premature ejaculation. [bmj.com]

• Fishing

  Ayurveda also implies proper Yoga Exercise for Premature Ejaculation (1) Kapaabhaati and Vajra Asana (2) Bow, Fish and Camel poses (3) Elevated lotus (4) Dhanusha Asana We at AstroKapoor.com have an excellent team of Ayurved. Mr. [astrokapoor.com]

  In the Massachusetts Male Aging Study, eating a diet rich in natural foods like fruit, vegetables, whole grains, and fish — with fewer red and processed meat and refined grains — decreased the likelihood of ED. Pay attention to your vascular health. [health.harvard.edu]

• Overeating

  This is significant, because there is debate over whether personal distress over a sexual difficulty is essential to making the diagnosis of a sexual dysfunction, as the DSM-V definition states. [contemporaryobgyn.net]

  RESULTS: An increasing number of studies assessing the incidence and prevalence of sexual dysfunction following multimodality treatment for rectal cancer has been published over the last 30 years. [ncbi.nlm.nih.gov]

  Women over 50 were most likely to experience sexual difficulties, although they were common in all age groups (over 60% of women aged over 50 reported lack of interest in sex, and more than half of women aged 16-49 also reported this difficulty). [healthengine.com.au]

• Lower Abdominal Pain

  Symptoms of PID include lower abdominal pain, fever, painful intercourse, painful urination, foul smelling vaginal discharge, irregular menstrual bleeding, and pain in the right upper abdomen. [beyondbasicsphysicaltherapy.com]

  Urinary Frequency / Urgency / Hesitancy Pain when Sitting Rectal / Perineum Pain Genital Pain Pain During Intercourse or Afterward Pain or Relief After Bowel Movement Lower Abdominal Pain Tailbone / Low Back Pain Stress Can Increase Pain Hot Baths or [pelvicpainhelp.com]

• Heart Disease

  It can be caused by physical problems and medical conditions, such as heart disease and hormone imbalances, or by psychological problems, like anxiety, depression and the effects of past trauma. [beaumont.org]

  Physical causes may include conditions like diabetes, heart disease, nerve disorders, or hormone problems. Some drugs can also affect desire and function. Psychological causes may include work-related stress and anxiety. [medlineplus.gov]

  and heart disease Pelvic surgeries, including surgical treatments for prostate cancer, colorectal cancers, bladder cancer and spinal cord conditions Lifestyle factors, such as excessive drinking, smoking, recreational drug use, and lack of exercise [health.ucsd.edu]

  disease High blood pressure (hypertension) Insomnia (difficulty sleeping) Sexually transmitted diseases Side effects of certain prescription and nonprescription medications Gynecological problems can also cause sexual dysfunction such as: Endometriosis [utswmed.org]

  Sexual activity is generally less taxing than moderate to heavy physical activity and is therefore usually safe for men with heart disease. [msdmanuals.com]

• Hypertension

  This has tended to affect the attitude of clinicians towards SD in female hypertensives. A woman who for over 15 years of hypertension and its treatment faced difficulties in all domains of sexual function is hereby reported. [ncbi.nlm.nih.gov]

• Heart Failure

  Nevertheless, sexually active men with disorders of the heart and cardiovascular system (which include angina, high blood pressure, heart failure, abnormal heart rhythms, and blockage of the aortic valve [aortic stenosis]) need to consult their doctor [msdmanuals.com]

  ED is a symptom that is linked to many health problems such as: Prostate problems Type 2 diabetes The testicles are not making hormones the way they should (hypogonadism) High blood pressure Vascular disease and vascular surgery Heart disease or heart [cedars-sinai.edu]

  […] attack (within six months) Uncontrolled, potentially life-threatening abnormal heart rhythms Severe liver disease Severe kidney failure requiring dialysis Severe heart failure or disease of the heart's valves, for example, aortic stenosis (hardening [medicinenet.com]

  failure, renal failure, stroke, and HIV). [ncbi.nlm.nih.gov]

  Women with heart failure are particularly prone to experience problems with vaginal lubrication and many report moderate to severe sexual pain. [patient.info]

• Muscle Spasm

  Inadequate lubrication and tense vaginal muscles make penetration painful. Involuntary vaginal muscle spasms, or vaginismus, can make intercourse hurt. These may be symptoms of neurological, urinary tract, or bowel disorders. [healthline.com]

• Back Pain

  This is a case report of a patient with bowel, bladder and sexual dysfunction associated with low back pain. This patient had an essentially normal neurological examination. [ncbi.nlm.nih.gov]

  Accidental Orgasms Rina Shaikh-Lesko | Jul 1, 2014 Meet the researcher struggling to gain approval for his medical device, which was originally designed to relieve back pain, but turned out to be an orgasm inducer. [the-scientist.com]

  In rare cases, the drug Cialis® can cause or increase back pain or aching muscles in the back. [urologyhealth.org]

  Urinary Frequency / Urgency / Hesitancy Pain when Sitting Rectal / Perineum Pain Genital Pain Pain During Intercourse or Afterward Pain or Relief After Bowel Movement Lower Abdominal Pain Tailbone / Low Back Pain Stress Can Increase Pain Hot Baths or [pelvicpainhelp.com]

• Low Back Pain

  This is a case report of a patient with bowel, bladder and sexual dysfunction associated with low back pain. This patient had an essentially normal neurological examination. [ncbi.nlm.nih.gov]

  Urinary Frequency / Urgency / Hesitancy Pain when Sitting Rectal / Perineum Pain Genital Pain Pain During Intercourse or Afterward Pain or Relief After Bowel Movement Lower Abdominal Pain Tailbone / Low Back Pain Stress Can Increase Pain Hot Baths or [pelvicpainhelp.com]

• Fear

  Type Factor Psychologic factors Abuse (emotional, physical, or sexual) during childhood or adolescence Anxiety Depression Fear of intimacy Fear of losing control Fear of losing the partner Low self-esteem Worry about inability to have an orgasm or about [merckmanuals.com]

  Mild dysfunction that is related to stress, fear or anxiety often can be successfully treated with counseling, education and improved communication between partners. [speakingofwomenshealth.com]

• Loss of Libido

  Case #3: A 28-year-old male with persistent loss of libido, genital anesthesia, and ejaculatory anhedonia since taking several different SSRIs over a 2-year period from 2003-2005. [ncbi.nlm.nih.gov]

  Male sexual dysfunction includes erectile dysfunction (ED), loss of libido (sexual desire), premature ejeculation and difficulty achieving orgasm. UC San Diego Health urologists provide a variety of treatment options for these common issues. [health.ucsd.edu]

  Loss of libido and interest Women with high blood pressure may have lower libido and less interest in sex, especially if the condition is contributing to fatigue. [heart.org]

• Frigidity

  Learn More in these related Britannica articles: frigidity Frigidity, in psychology, the inability of a woman to attain orgasm during sexual intercourse. [britannica.com]

  Sexual arousal disorders were previously known as impotence in men and frigidity in women, though these have now been replaced with less judgmental terms. [pharmatutor.org]

  Impotence is now described as erectile dysfunction and a number of terms exist to describe frigidity. These individuals may have an aversion to or tendency to avoid sexual contact with a partner. [news-medical.net]

  New findings point to relationship issues as the primary cause of female sexual dysfunction Credit: Justin Horrocks/iStockphoto Formerly known as frigidity, female sexual dysfunction (FSD) has always been a controversial diagnosis, and now studies are [scientificamerican.com]

  Sexual arousal disorders were previously known as frigidity in women and impotence in men. These have now been replaced with less judgmental terms. [web.archive.org]

• Anhedonia

  Case #3: A 28-year-old male with persistent loss of libido, genital anesthesia, and ejaculatory anhedonia since taking several different SSRIs over a 2-year period from 2003-2005. [ncbi.nlm.nih.gov]

  A condition called anhedonia, which is depression related may also cause a reduction in sexual urge and arousal.Also, treatment with some drugs such as the the selective serotonin reuptake inhibitors (SSRIs) usually cause SD in both men and women by reducing [symptoma.com]

  Anhedonia (sexual) F52.2 Failure of genital response The principal problem in men is erectile dysfunction (difficulty in developing or maintaining an erection suitable for satisfactory intercourse). [onlinelibrary.wiley.com]

• Excitement

  Desire leads to the first stage of the sexual response cycle, excitement. Excitement, or sexual arousal, follows. During excitement, the brain sends nerve signals down the spinal cord to the penis. [msdmanuals.com]

  The sexual response cycle traditionally includes excitement, plateau, orgasm, and resolution. Desire and arousal are both part of the excitement phase of the sexual response. [my.clevelandclinic.org]

  The sexual response cycle traditionally includes excitement, orgasm, plateau, and resolution. Arousal and desire are both parts of the excitement phase of the sexual response. [pharmatutor.org]

  The sexual response cycle traditionally includes excitement, plateau, orgasm and resolution. Desire and arousal are both part of the excitement phase of the sexual reponse. [speakingofwomenshealth.com]

• Stroke

  Following stroke, more than half of patients experience sexual dysfunction. Other risk factors include certain medications, psychological issues, dependence on others for daily tasks, and the presence of other diseases, including diabetes. [aapmr.org]

  Brain disorders (that do not affect libido but have neurological consequences that affect sexual functioning), including brain tumor and stroke. Spinal cord disorders, such as multiple sclerosis or spinal cord trauma. [bumrungrad.com]

  […] and stress, concerns about sexual performance or relationship problems Conditions that cause impaired blood flow, such as cardiovascular disease, high blood pressure and diabetes Neurological and neuromuscular conditions, such as multiple sclerosis, stroke [health.ucsd.edu]

  Calculator What's your risk for a heart or stroke event? Last Reviewed: Oct 31, 2016 [heart.org]

  Conditions affecting the lungs, liver, kidneys, nerves, arteries, or veins Conflicts or lack of communication between partners Endocrine disorders Excessive tobacco use, especially in men Health problems that can inhibit sex, such as Parkinson's disease, stroke [utswmed.org]

• Agitation

  Chronic worry, anxiety and nervous agitation in pelvic pain patients results in chronically tightened muscles in the pelvis that remain sore, unable to heal. [pelvicpainhelp.com]

• Sexual Dysfunction

  Dysfunction | Other Male Sexual Dysfunction | Substance-Induced Sexual Dysfunction American Psychiatric Association : Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. [web.archive.org]

  Finally, various aspects of sexual experience result in an increased risk of sexual dysfunction. [doi.org]

  Sexual dysfunction is a key adverse effect leading to medication noncompliance. Psychotropic drugs associated with sexual dysfunction include antiepileptic drugs, antidepressants, and antipsychotics. [ncbi.nlm.nih.gov]

• Premature Ejaculation

  Premature Ejaculation Treatment Premature ejaculation is a condition in which a man reaches orgasm sooner than his partner. It can take place either before or shortly after mating. [astrokapoor.com]

  Premature ejaculation, lack of sexual desire, lack of pleasure during intercourse, and difficulty reaching orgasm were most prominent in hindering men’s sex lives. [contemporaryobgyn.net]

  SD in diabetics with problems of impotence/vaginismus, premature ejaculation/anorgasmia, nonsensuality and avoidance has an adverse effect on the SQoL-P of their partners. [ncbi.nlm.nih.gov]

  Premature ejaculation Premature ejaculation is when ejaculation occurs before the partner achieves orgasm, or a mutually satisfactory length of time has passed during intercourse. There is no correct length of time for intercourse to last. [pharmatutor.org]

  CBT for both premature ejaculation and erectile problems focuses on removing the pressure to perform. [beckinstitute.org]

• Female Sexual Dysfunction

  Female sexual dysfunction can be founded by disorders of sexual desire, arousal, orgasm, and sexual pain. Physiologic sexual dysfunction can, in many cases, be the result of impaired neurovascular tone to the clitoris and vagina. [ncbi.nlm.nih.gov]

  What is Female Sexual Dysfunction (FSD) Statistics on Female Sexual Dysfunction (FSD) Risk Factors for Female Sexual Dysfunction (FSD) Progression of Female Sexual Dysfunction (FSD) Symptoms of Female Sexual Dysfunction (FSD) Clinical Examination of Female [healthengine.com.au]

  Continued How Is Female Sexual Dysfunction Treated? The ideal approach to treating female sexual dysfunction involves a team effort between the woman, doctors, and trained therapists. [webmd.com]

• Vaginal Dryness

  Vaginal dryness can result from hormonal changes that occur during and after menopause or while breastfeeding, for example. Psychological issues, like anxiety about sex, can also cause vaginal dryness. [everydayhealth.com]

  Therefore, perimenopausal and menopausal women often experience sexual problems, especially lack of sexual desire, vaginal dryness and painful intercourse. [hoag.org]

  Sexual dysfunction, including problems with vaginal dryness, dyspareunia, decreased libido, and difficulty with orgasm, is a common complaint among female breast cancer survivors. [ncbi.nlm.nih.gov]

  Females report more sexual dysfunction than males Half of the women surveyed (52%) reported at least one sexual dysfunction, most commonly lack of sexual desire and difficulty reaching orgasm, followed by pain during intercourse and vaginal dryness. [contemporaryobgyn.net]

  Breastfeeding: Vaginal dryness can contribute to genitopelvic pain/penetration disorder. Psychologic and social stressors: Changes in family roles and relationships, sleep disruption, neonatal health issues, and/or weight gain can increase stress. [merckmanuals.com]

• Dyspareunia

  | Vaginismus Sexual Dysfunction Due to a General Medical Condition : Female Dyspareunia | Female Hypoactive Sexual Desire Disorder | Male Erectile Disorder | Male Hypoactive Sexual Desire Disorder | Male Dyspareunia | Other Female Sexual Dysfunction [web.archive.org]

  Using ordinal regression analysis, we identified characteristics and conditions associated with decreased libido, infrequent orgasm, decreased arousal, and dyspareunia. [ncbi.nlm.nih.gov]

  Dyspareunia is the most common type of PPFSD. [bjmp.org]

  Specific diagnoses include lack or loss of desire, sexual aversion and lack of sexual enjoyment, vaginal dryness, markedly delayed or nonexistent orgasm, vaginismus and dyspareunia not attributable to physical problems and excessive sexual drive. [apa.org]

Diagnosis of sexual dysfunction usually involves comprehensive history taking from both sex partners, either individually or collectively. General information about the observed symptoms, medications and other clinical conditions. Also, mental hand social status of the patient are important. These include, patient  relationship status, self-evaluation, mood, self-esteem, previous sexual experiences, including personality traits.

Female patient with complaint of sexually related pain may require pelvic examination, which are carefully done by the clinician. The use of special instrument such as vaginal speculum may not be necessary during the diagnosis depending on the discretion of the clinician. However, in case of sexually transmitted diseases,  speculum may be required to open the vagina canal for specimen collection (either high vaginal swab (HVS) or endocervical swab (ECS)). The samples are collected for microbiological test for cultural technique to identify the disease-causative agents. Generally, there are no specific laboratory investigations which are known to be recommended in diagnosing FSD, however, laboratory techniques such as normal Pap and stool guaiac (faecal occult blood) tests may assist in diagnosis. Chemistry test such as hormonal analysis may be requested. These include, prolactin (PRL), estradiol, sex steroid-binding globulin (SSBG) or sex hormone-binding globulin (SHBG), thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) and total and free testosterone (TTFT) hormone levels, .

Both primary and secondary forms hypogonadism can be evaluated using FSH and LH. An increase in FSH and LH may indicate primary gonadal failure, while reduced levels shows an impairment of the pituitary region of the hypothalamus. Reduced estrogen levels in the body can result into reduced libido, vaginal dryness, and painful intercourse (dyspareunia). Lack of testosterone may also cause FSD, including reduced libido, arousal, and satisfaction. The level of SHBG usually increases with age but often decreases by using an exogenous estrogens [28]. Also, hyperprolactinemia may lead to reduction in libido.

Different forms of therapy are used in managing sexual dysfunction. These ranges from mental therapy to medications. Patient are counseled to improve the sexual relationship through a clear, open and effective communication and apply best method to achieve sexual satisfaction. These may assist in treating sexual dysfunction.Another psycho-social treatment involving the use of cognitive-behavioral approach and/or mindfulness, may aid treatment of sexual dysfunction which is related to mental issues.
Therapeutic approach may involve hormone replacement treatment which may change the sexual urge. Menopausal and premenopausal women may be treated with estrogen which can improve the sensitivity of clitoral stimulation, enhance atrophied vaginal muscle, and reduce dyspareunia. Estrogen may also improve symptoms associated with vasomotor diseases, mood disorders, including symptoms observed with urinary frequency or urgency [29]. In addition, estrogen replacement used in managing postmenopausal women, may help in ameliorating urogenital atrophy which constitute one of the causes of arousal. Treatment with progesterone may be used for women having intact uteri using estrogen, it has contraindication of affecting mood negatively as well as contributing to a reduced sexual desire. There are controversial report as regards the therapeutic use of testosterone in treating premenopausal women with androgen deficiency, however, it is known to  directly increase or stimulate sexual desire. Testosterone replacement are usually recommended for clinical conditions such as premature ovarian failure, symptomatic form of testosterone deficiency in pre and postmenopausal women that develops naturally, surgically, or induced by chemotherapy [29]. Presently, there are no any national guideline for treating sexual dysfunction using testosterone replacement for women and also there are no known, designated therapeutic regimen of testosterone therapy is acceptable as standard in managing women with sexual dysfunction [27].
SD resulting from arousal disorder may be due to insufficient stimulation, fear, and urogenital atrophy.  A study involving the use of sildenafil (Viagra) in treating arousal disorder among 48 women revealed a significantly increase in physiological markers associated with a satisfactory sexual response in female [30]. Sexual arousal disorder may also be improved by increasing foreplay, distraction approach, relaxation and use of lubricants, vitamin E including mineral oils. After therapy, most women having sexual dysfunction due to orgasmic disorders usually show significant improvement. Sex therapists usually counsel women to improve on the stimulation technique and reduces difficulties in vaginal penetration. Vaginal muscle tone and sexual tension are enhanced by pelvic muscle exercises while masturbation method including vibrator usage can improve stimulation. Distraction approach such as fantasy, music has proven to be effective as well [26].

Sexual pain are usually classified into; superficial, vaginal, and deep pain. Superficial pain is due to vaginism, anatomic defects, or conditions causing irritations of the vaginal mucosa. Vaginal pain is caused by irritation or friction due to reduced lubrication while the deep pain may be due to muscular problems or due to pelvic disease [27]. Sexual pains may be treated with lubricants, estrogens, lidocaine (topically administered), vaginal moistening, Non-steroidal anti-inflammatory drugs (NSAIDs), pelvic physical therapy, and postural changes. Women with vaginism or vaginismus are better managed by sex therapy which often result from traumatic experience or sexual abuse history.

Different factors such as the demographic information (e.g age) are very significant in predicting the sexual problems, especially erectile dysfunction.  SD are commonly observed among young adult women and aged men. These differences in prevalence is due to many factors which influences the outcome of the condition. Because young adult women may be probably single, there are possibilities of periodic times of sexual inactivities and sometimes, increase risk of partner turnover which may cause negative sexual experience. This may result into sexual difficulties and anxiety which may also be influenced by inexperience. This may be contrasting to the experience of young adult men sexual activity. However, older men may have reduced interest in sex and difficulties in producing or maintaining erection. Symptoms such as low sexual desire and erectile dysfunction are commonly age-dependent conditions, possibly due to physiological changes that are related to aging.

Factors which include, poor medical condition and unhealthy lifestyle are also demographic conditions which may determine the outcome of sexual response. Sexual dysfunction in unmarried women may vary depending on the individuals sexual  sexual lifestyles. Similarly, increased risk of SD commonly observed among less educated and low income earner showed that education and income play some roles in determining the level of sexual satisfaction.

Common cause of sexual dysfunction include, smoking, obesity, high blood pressure, diabetes as well as dyslipidemia. These are the major cause of erectile dysfunction particularly among the elderly men [2] [3] [4]. Although, erectile dysfunction are known to be related to vascular commodities, previous study involving neural computational networks revealed the relationship between the age, total testosterone level including depression scale with moderate erectile dysfunction open link (ED) [5]. Lower urinary tract infection has been implicated to be a major risk factor of sexual dysfunction among all age groups [6] [7]. with relative risk value of about 1.8–7.5% of ED occurrence among individuals with LUTS [8].

Sometimes, women may have an occasional or periodic difficulties associated with sexual activity or decreased urge and ability to reach orgasm or painful sexual intercourse. Increase in the manifestation of these symptoms is indicative of SD, which may be due to an underlying disease [9] [10]. Sexual dysfunction in female (FSD) have been reported in about 30–50% among women population and known to be associated with age, educational status, physical and emotional health [11] [12] [13]. The dysfunction in women can also be associated with the male partner's sexual ability as it is reported that corrections of erectile problems increases women's sexual urge, orgasm and overall sexual satisfaction [14].

Another factor which could cause FSD is depression, accounting for 70% of cases and may be severe during treatment. Therefore, the choice of drugs must not impair sexual activity [15]. Most often, sexual dysfunction may develop as a consequence of main depressive disorder although, it is not referred as the symptoms of the disorder. A condition called anhedonia, which is depression related may also cause a reduction in sexual urge and arousal.Also, treatment with some drugs such as the the selective serotonin reuptake inhibitors (SSRIs) usually cause SD in both men and women by reducing libido, while drugs which include bupropion hydrochloride, mirtazepine (remeron) and nefazodone do not cause ED or FSD often [16] [17]. Sildenafil are often recommended in cases where antidepressants result into SD [18]. Tricyclic antidepressants (TCAs) have less contraindicating properties on sexual desire, however, the anticholinergic side effects may cause LUTS and any related SD. Dopamine antagonists such as neuroleptic drugs that increase prolactin cause decrease in libido by acting as testosterone antagonist.

The prevalent rate of sexual dysfunction among women (43%) is higher than men (31%) and is usually related with different demographic features such as age and educational status. There are different patterns of SD among women population depending on the racial background. Psychological and physical factors can also influence the development of sexual dysfunction, as the problem is more common among individuals with poor health conditions including emotional instability. Also, social issues such as unpleasant sexual experience as well as general well-being may result in sexual dysfunction is highly associated with  in sexual relationships.The statistical analysis of the prevalence of SD among male and female involving 27,000 subjects between 40–80 year age groups, within year 2001 and 2002 in 29 countries showed that about 28% and 39% population of men and women respectively reported one or more forms of sexual dysfunction.

In men, ED usually increases with age while in women, loss of sexual urge and failure to attain orgasm (anorgasmia) are common with no age dependence. A comparative study carried out involving clinical and non-clinical subjects showed higher prevalence of FSD among clinical subject with the effect of age factor [19] [20].

The sexual dysfunction in female (FSD) may either be physiologic or psychological in nature. Physiologically, sexual stimulation is initiated from the medial preoptic area, hypothalamus (anterior side), and limb-hippocampal part of the central nervous system (CNS). Electrical impulse are then sent through both parasympathetic (PNS) and sympathetic nervous systems (SNS) [21].

Chemical mediators which include neurotransmitters (such as neuropeptide Y (NPY) and vasoactive intestinal polypeptide (VIP)), nitric oxide synthase (NOSs), cyclic guanosine monophosphate (cGMP), and substance P are detected in the nerve fibers of the vaginal muscle . Nitric oxide (NO) is known to be involved mediating clitoral stimulation and labial engorgement, while vasoactive intestinal polypeptide (VIP) is a non-adrenergic neurotransmitter,which enhances blood flow and proper lubrication of the vaginal through secretions [22].

Different physiological changes are observed in the female reproductive system during sexual stimulation. There is an increase in the blood flow initiated by vasocongestion in the genitalia. Also, cells from both uterus and Bartholin glands secrete fluid which help in lubricating the vaginal canal wall. The smooth muscle in the vaginal wall usually relaxes and assists in dilation or extension of the vagina. Moreover, following clitoral stimulation, the size of the clitoris increases and becomes engorged due to an increased blood flow in the the labia minora.

Response cycle in female during sexual activity was first described in the year 1966 by Masters and Johnson. The cycle was classified into four phases, which include, the excitement stage, plateau stage, orgasm, and resolution stage [23]. This theory was adjusted by Kaplan in the year 1974, and classified into three-cycle model which include, desire, arousal stage, and orgasm period [24]. Basson on the other hand proposed a new theory of sexual response cycle among female [25], stating that the urge to improve intimacy or closeness induces female sexual response. The cycle starts on a neutral, sexual activity level and changes to an arousal stage after the signal from sexual stimulus. Arousal stimulates the sexual urge, and hence, inducing the female's readiness to respond and absorb more additional stimuli. Increased sexual desire ultimately result into satisfaction both emotional and physically including intimacy. Different factors either biological or psychological may negatively alter the sexual cycle, thereby resulting into FSD.

It is important to identify and understand the type or form of the sexual dysfunction affecting the patient as there may be more than one types and may be inter-related in development. As an example, a patient with complaint of reduced sexual desire may have an underlying primary orgasmic problems due to inadequate stimulation. Therefore, the reduced sexual desire is not the major symptoms but a secondary response resulting from unfulfilled sexual activity [26]. In this case, treatment administered for the orgasmic disorder may indirectly improves the sexual desire while, the treatment for the former condition may a not yield the expected result. Hence, this may cause more pschological problems relating to dysfunction.

Sexual dysfunction is prevented by identifying and avoiding the possible causes which result into the condition. As an example, diseases which include, diabetes and hypothyroidism which could lead to SD must be appropriately treated. A change of medication or drug dosage should be monitored for any possible contraindication. In cases where etiological factor can not be established, an effective treatment regimen should be done. This management may involve an encouragement or counseling on the need for proper sexual attention including increase in genitalia stimulation. Increase in sexual satisfaction may be achieved by using sex videos, books, as well as masturbation.

Also, the condition can be prevented by engaging in pelvic muscle therapy during sexual intercourse and employing distraction methods such as background music, exciting fantasy is helpful in eliminating anxiety and increases body relaxation. Sexual dysfunction forms like erectile dysfunction may be prevented using noncoital behavioral approach, such as body massage and oral sex. In addition, the use vaginal lubricants and moisturizers including positional or postural changes, with nonsteroidal anti-inflammatory (NSAIDs) drugs may prevent or reduce dyspareunia [30].

Sexual dysfunction is usually characterized by impairment in sexual urge or desire and affect the psycho-physiological  behavioral changes in relation to the sexual response stages both in male and female [1]. These dysfunctions include, pain during intercourse or sexual discomfort, vaginal pain caused by muscle spasm or contraction, and problems associated with sexual urge, arousal, or reaching orgasm which may be a challenge. Generally, about 30-50% of women population are reported to have experienced sexually related problems at a particular time of their life. Depending on the severity of the condition, affected individual may be distressed or psychologically disturbed.

Sexual dysfunctions (SD) is a condition associated with the disturbances or problem of sexual desire including psycho-physiological changes that is related with sexual responses in both men and women. SD may include, painful sexual intercourse, vaginal pain caused by muscle spasm or contraction, and other sex related problems such as reduced sexual urge, stimulation, or orgasm which are usually disturbing.

Among the elderly men, factors such as smoking, hypertension (HTN), obesity, diabetes and dyslipidemias  usually contribute to erectile dysfunction. Among women, depression has been implicated as one of the causes of sexual dysfunction in females accounting for more than 70% of cases and may be worsened during treatment. Drugs used in treating depression, which are referred to as selective serotonin reuptake inhibitors (SSRIs) are known to cause SD in both men and women, by reducing sexual urge. Other drugs such as bupropion hydrochloride, mirtazepine (remeron) and nefazodone seldomly cause ED or FSD.

The diagnosis of sexual dysfunction are easily managed if there is an observable signs or symptoms because some women may broadly classify sexually related problems as a reduction in sexual urge or general dissatisfaction. Some women may specifically complain about pain during sexual stimulation or during intercourse, anorgasmia, retarded orgasm, and reduced sexual arousal. Diagnosis are made by series of detailed, sex history of both sex partners individually and collectively. Although, there are no specific laboratory investigations, that is universally recommended in the diagnosis of FSD, common tests such as normal Pap smears and (fecal occult blood) tests may assist in diagnosis. Other test such as high vaginal swab (HVS), endocervical swab (ECS), hormonal assay may be requested by the Clinician. Different approach are used in treating sexual dysfunction, depending on the discretion of the Clinician. Apart from medication, general counseling about open communication in relationship and arrangement of convenient sex environment are also helpful in treating sexual dysfunction. Also, cognitive-behavioral therapy including mindfulness and psychotherapy are helpful in managing sexual dysfunction.

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