SingaporeMotherhood | Baby & Toddler
Is Female Sexual Dysfunction (FSD) making it hard for you to have sex and get Pregnant?
Low sexual desire. Rarely reaching orgasm. These were the two most common (out of six) sexual disorders that women in Singapore reported in a 2021 KKH study on women who were planning for pregnancy. The study, which involved over 500 women of reproductive age, showed that nearly 60 per cent of women in Singapore were at risk of developing female sexual dysfunction (FSD), a condition where the woman has persistent recurrent problems with sexual response.
Globally, FSD — which can include difficulties with desire, arousal, and orgasm, or penetrative pain lasting more than six months that causes distress to her and/or her partner — affects 30 to 50 per cent of women of all ages.
In Singapore, the most common form of FSD is vaginismus, where women experience pain during attempted penetration. During the COVID-19 pandemic in 2020, the Sexual Health Clinic at KK Women’s and Children’s Hospital (KKH) saw 100 new cases of vaginismus. This was a 60 per cent increase compared to 2017.
For women who are trying to have a baby, FSD can be a particularly cruel condition to have. “They (the women) are usually in their 30s. They come after discovering the problem post-marriage, or seek help when they wish to conceive,” shares Dr Tan Tse Yeun, a Senior Consultant at KKH’s Department of Reproductive Medicine. She tells us more below.
How FSD affects conception
Couples who are trying to conceive or who are sub-fertile may experience more sexual difficulties. These make it harder for them to conceive, hence they take a longer time to achieve pregnancy. For instance, women with low sexual function see their chances of conceiving within the year drop by 27 per cent as compared to those with high sexual function.
Typically, women who are physically inactive, and those with depression or anxiety symptoms, also have poorer sexual function.
The psychological distress resulting from FSD may also bring upon an inflammatory response where stress-related glucocorticoid (a kind of steroid) changes affect the reproductive hormonal balance. This in turn can interfere with ovulation. All these contribute to the delayed time to conceive.
Dyspareunia and vaginismus are common types of FSD. Both are now classified under the umbrella term of genito-pelvic pain/penetration disorder (GPPPD).
Vaginismus is a condition where the muscles in the vagina tighten involuntarily and prevent any object from entering the vagina.
Women with vaginismus have an intense fear of, and anxiety about pain before or during vaginal penetration. When they anticipate that pain will recur during penetration, their vaginal muscles tighten. This makes subsequent attempts at sexual intercourse even more painful. Because of this, they are not able to consummate their marriage, despite being married for years.
Vaginismus may also prevent them from undergoing intra-vaginal gynaecological health checks such as a pap smear or a vaginal ultrasound. Hence, vaginal intercourse and vaginal medical examinations during gynaecology and fertility assessments and treatments are not possible.
Dyspareunia is a symptom of genital pain associated with penetrative sexual intercourse. It can be superficial or deep. Dyspareunia is associated with vaginismus (involuntary muscle spasm) but can be due to other medical conditions such as vulva infection. It can also be due to vulva skin conditions such as vulvovaginal atrophy after menopause, or gynaecology diseases in the pelvis such as endometriosis or vagina septum.
What causes FSD?
The cause of sexual pain disorders is not clear. However, sexual issues are always multifactorial. Past experience of trauma, abuse, and negative sexual experiences also have links with sexual pain. Social background such as family upbringing, and religious and cultural attitudes can also influence how a woman views sex.
Furthermore, there are also stages in a woman’s life where she may experience more sexual problems. These include, for instance, if she is struggling with infertility, just had a baby, or is going through menopause. Medical conditions such as vaginal infections can also contribute towards sexual issues, so it is important to see a gynaecologist to exclude them.
Not to forget, it takes two to tango. A woman’s sexual experience is very much related to her partner’s sexual function and their relationship.
Where to get help for FSD
KKH has been providing care and support for patients with FSD since 1994. Its Sexual Health Clinic housed under the KK Women’s Health and Wellness Centre manages an average of 90 to 100 new cases of FSD per year.
The SHC team comprises a doctor, a psychologist and a physiotherapist, who work hand in hand to provide a holistic treatment approach.
Treatment options typically involve treatment of contributing medical conditions, sexual education, therapy and emotion regulation work, pelvic floor muscle rehabilitation and/or relationship counselling.
Sexual disorders can be successfully treated when patients trust and work closely with a multi-disciplinary team to address their concerns early. We have had many patients who have successfully conceived and have healthy babies.
What if we do not treat FSD?
Left untreated, FSD can affect the woman and her partner’s mental and physical health, relationship and quality of life. For sexual pain disorder conditions such as vaginismus, the inability to have penetrative intercourse can strain a couple’s relationship.
Women who suffer from sexual pain disorder often report lack of desire for sex and lack of arousal during sex. Husbands also fear hurting their wives. Hence, couples often stop being sexually intimate altogether. This is a major barrier for couples who wish to start a family.
Hence, FSD can affect mental and physical health, relationship and quality of life for both a woman and her partner. It is also a key barrier to conception and procreation. Therefore, couples should seek help earlier to optimise treatment outcomes.
Dr Tan Tse Yeun is a Senior Consultant with the Department of Reproductive Medicine at KK Women’s and Children’s Hospital (KKH). An accredited in-vitro fertilisation (IVF) specialist and a Fellow of the European Committee of Sexual Medicine, Dr Tan subspecialises in assisted reproductive programmes, reproductive surgery, female sexual health conditions, and infertility. Dr Tan was also instrumental in the establishment of the Sexual Health Clinic in KKH. Aside from her clinical work, Dr Tan is also an avid educator and passionate researcher who teaches at all three medical schools in Singapore.
Dr Tan was a speaker at the recent Know Your Fertility Wellness Campaign by I Love Children (ILC). The campaign aims to encourage more couples to be aware of their fertility health and go for fertility consultations together. Visit www.ilovechildren.sg to learn more about your fertility health today.
All content from this article, including images, cannot be reproduced without credits or written permission from SingaporeMotherhood.