Dr Tan Tse Yeun, Consultant from the Department of Reproductive Medicine at KK Women’s and Children’s Hospital (KKH), answers your questions on female sexual dysfunction (FSD).
Female sexual dysfunction (FSD) is a common problem that can affect women of all ages.
FSD affects 30 to 50 per cent of women and can substantially impact the woman and her partner’s health, relationship and quality of life. Yet, it is a condition that is under-recognised and under treated.
Here’s your chance to ‘Ask the Specialist’ –
Dr Tan Tse Yeun, Senior Consultant from the Sexual Health Clinic at
KK Women's and Children's Hospital (KKH), a member of the
SingHealth group. Dr Tan will be addressing questions on this topic in this Q&A forum.
This 'Ask the Specialist' forum has closed. Thank you for your interest and participation.
1. Question by B*****
After giving birth, I've loss all interest in having sex with my husband. I've tried doing it as my husband has been initiate for the longest time, but it's not the same feeling as before. It becomes a chore rather than doing something cos I want it. I'm not sure why this is happening as I was usually the one initiating it before giving birth. FYI, I had c sect and I'm only in my mid-30. I thought this will get better after 3 years but it doesn't seems so.
Answered by Dr Tan:
Hi B*****,
With the birth of a child, many people experience several changes in their life. This could be changes in terms of physical and emotional functioning, relationship with their spouse as well as coping with the increased responsibilities of parenthood. Some of these can cause stress and impact the couple’s sexual relationship and communication. I encourage you to visit a Sexual Health Clinic for a more comprehensive assessment which includes medical, pyscho-social and pelvic muscle evaluation so that your challenges can be addressed.
2. Question by h******
I am always not interested in sex. If there anyway or any drug to take so that I will feel more sexy and interested in sex ? Thank You.
Answered by Dr Tan:
Hi,
There are many reasons why someone might not feel the desire to engage in sexual activity. These could range from medical reasons such as depression, the experience of emotional stress in other areas of life or negative relationship dynamics between partners. Sexual desire drugs are not approved for this use in Singapore and they do not improve desire in the long run. Therefore, a quick fix does not exist and it is more useful to explore and target the underlying reasons for the lack of desire so interventions can be more effective.
3. Question by w******
Pl specifically define FSD. It is similar to the Male ED?
Taking a long ime to reach climax consider FSD??
Is using HRT like Vagifem safe?
Is using external aids encouraged - like a Quality Dildo
Psychological factors - how to overcome these?
Answered by Dr Tan:
Hi w******,
Female Sexual Dysfunction (FSD) is defined as having persistent recurrent problems with sexual response, desire, orgasm or pain that cause distress to an individual and/or her partner. There are various types of FSD and they often tend to overlap. Causes of FSD are usually multi-factorial with psychological factors being one of them. It is not possible to go into detail on management plans as different issues require an individualised approach.
The use of Hormone Replacement Therapy should be discussed with your doctor who will take into consideration your medical condition, and weigh the risks versus benefits with you.
There is no guideline on the duration a woman should take to achieve orgasm. It is only a dysfunction if it causes distress to you or your partner. Similarly, the use of sex toys is neither encouraged nor discouraged. It is for both partners to make a mutual decision as to whether this would help enhance the sexual experience.
A psychiatrist and psychologist are the healthcare professionals who manage psychological factors. A psychiatrist can prescribe medications if required but they often work hand in hand with psychologists. Counselling-based strategies are available for different conditions and have been shown to be effective but would need to be individualised and sometimes combined with medical or physical therapy to be more effective.
4. Question by s********
I have very low libido and it's affecting my relationship. Have tried talking to 2 GP but they say I'm probably stressed. It's been many years already. I don't know where to seek help. I am in my early 50s and have had a hysterectomy 6 yrs ago. I was also diagnosed with Major depression 11 yrs ago but has since been discharged.
Answered by Dr Tan:
Hi,
There are many reasons as to why someone might not feel the desire to engage in sexual activity.
Life changes such as menopause is commonly associated with changes in sexual function. Menopause can be natural onset or comes with the removal of the ovaries during hysterectomy (a surgery to remove all or part of the womb). The reduction in estrogen can cause general changes in the body, vagina and mood which can be responsible for the changes in sexual function.
These can also cause changes in your relationship (sexual and non-sexual) with your partner. It is also common for a person who is depressed or taking anti-depressants to have no desire for sex. Emotional stress in other areas of life or other difficulties in the relationship can also contribute.
It is useful to explore and target the underlying reasons for the lack of desire so interventions can be more effective. I encourage you (and your partner) to visit a Sexual Health Clinic for a more comprehensive assessment so that your challenges can be addressed.
5. Question by A******
I'm 43, diagosed with mild stroke, diabetes, cholesterol and BP.. which affected my sexual dysfunction & intimacy interest with my partner.. is there anything that can help the situation?
Answered by Dr Tan:
Dear A******,
The desire to engage in sexual activity is dependent on various factors. Chronic medical conditions such as diabetes, high blood pressure, and some of the medications used to manage the conditions can also be associated with low desire.
Acute medical conditions such as a stroke can cause health changes which affects not only sexual function but also general function. This can be due to physical changes (e.g. in sleep and mobility), mood changes (e.g. anxiety due to fear of recurrent stroke) and new stressors such as that of coping with a chronic medical condition. Medical issues can cause emotional distress which may need to be addressed first before working on sexual health difficulties.
It is important to optimise your cardiovascular, cerebrovascular health and undergo rehabilitation as per the advice of your cardiologist/neurologist to improve general function. This may also improve sexual function.
Some of the approaches utilised at the KKH Sexual Health Clinic will include advice on sexual positioning as well as addressing negative thoughts concerning sexual activity as well as body image issues following a stroke.
Medical conditions do not only affect the patient alone. It is also important to evaluate the impact on the partner and assist in helping the couple adjust to the changes brought about by the medical condition.
6. Question by Y**
Dear Dr Tan,
Due to ER positive breast cancer, my oncologist has put me on tamoxifen and this has caused painful to impossible intimacy. I have tried multiple external or internal non oestrogen moisturiser but nothing works.
Please help me, I am very steed over this issue and is affecting my relationship and quality of life too. Thank you.
Answered by Dr Tan:
Dear Y**,
Sexual difficulties are common in patients diagnosed with cancer. There are many reasons as to why intimacy can be impacted by breast cancer and the necessary therapy. Physical changes after surgery or radiation and body image issues after the loss of a breast are some of the reasons. The function of chemotherapy and Tamoxifen is to reduce estrogen who can cause menopause-like symptoms. The inability to conceive while undergoing cancer treatment and fear of premature menopause can cause distress in young breast cancer survivors.
The use of vagina moisturisers is helpful for vagina symptoms of dryness and painful intercourse and I would recommend for you to continue them. An examination of the genitalia and pelvic muscles to assess the health of vagina tissues and muscle strength maybe helpful to rule out potential issues. If so, pelvic floor training may help local vagina symptoms.
I would also encourage you to expand your definition of sexual intimacy beyond the traditional idea of penile-vaginal penetration. There are various ways to achieve sexual intimacy and it is important that you communicate about your difficulties with your partner for a start. Both of you could then work together to explore other forms of intimacy that might be equally satisfying at this point in time.
7. Question by E**
Hi Dr,
Is it true that sexual intercourse for postmenopausal woman who are past 65 will help to delay the ageing process?
Answered by Dr Tan:
A fulfilling sex life is an important part of health, and sexual satisfaction contributes to overall quality of life. Even though there is no strong scientific evidence to prove that it will delay ageing, it can provide mental and physical health benefits and may help to maintain your flexibility.
8. Question by J*
Hi Dr Tan,
I am a female patient diagnosed with a chronic immune disease. Since my marriage almost 10 years ago, I have not been intimate with my husband as there is extreme pain due to dryness.
I have consulted a few gynaecologists and even therapist in this area, but no one can find a solution for us. Their advice usually center around more lubricants. I am also discouraged that with an almost non-existent intimate life, I had a case of herpes 4 years ago. That put more fear that I will cause my husband harm. Can you give me any advice or suggestion.
Answered by Dr Tan:
Dear J*,
Patients diagnosed with autoimmune conditions such as Sjogren’s syndrome can have sexual difficulties such as chronic dyspareunia (painful intercourse). A multidisciplinary approach is especially important in the management of chronic autoimmune conditions where the aim is to manage symptoms and improve quality of life. This includes the use of regular vagina moisturisers, tailored exercises to reduce pain and fatigue, pelvic floor assessment and rehabilitation, in combination with psychological approaches which is provided at the KKH Sexual Health Clinic.
The diagnosis of genital herpes infections can cause anxiety in patients who are worried about the impact on their health as well as sexual transmission to their partners.
Counselling about the course of the infection, transmission risk, and methods to reduce transmission may help to reduce the anxiety. KKH provides comprehensive services including screening, treatment, contact tracing and sexual health counselling for patients who have sexually transmitted infections.
About Dr Tan Tse Yeun
Dr Tan Tse Yeun is a Senior Consultant with the Department of Reproductive Medicine at the KK Women’s and Children’s Hospital (KKH). She is an accredited IVF (in-vitro fertilisation) specialist and a Fellow of the European Committee of Sexual Medicine.
Dr Tan’s sub-specialties are in assisted reproductive programme, reproductive surgery, female sexual health conditions, and
infertility. She was also instrumental in the establishment of the Sexual Health Clinic in KKH.
As an avid educator, Dr Tan teaches at all three medical schools in Singapore. She is a Clinical Lecturer at the Yong Loo Lin School of Medicine, Clinical Faculty Member of the Lee Kong Chian School of Medicine, as well as Adjunct Instructor at the Duke-NUS Medical School.
Dr Tan is also a Physician Faculty Member for the
Obstetrics and Gynaecology Residency Programme in SingHealth and also collaborated with the KKH interprofessional task force to design and deliver a series of educational workshops on sexual health communication for healthcare students from multi-disciplinary backgrounds (nurses, allied health and medical).
Because #healthiswealth #healthforgood
Ref: K21
