Disfunção Sexual Feminina
Conheça um estudo do FDA entrevistando mulheres que sofrem com DSF - Disfunção Sexual Feminina.
Embora as participantes da pesquisa fossem mulheres americanas, estou segura que muitas mulheres no planeta, entre 15 e 95 irão passar por uma DSF. De fato, uma em cada três mulheres experimentam estes sintomas.
The Voice of the Patient
A series of reports from the U.S. Food and Drug Administration’s (FDA’s)
Patient-Focused Drug Development Initiative
Female Sexual Dysfunction
Perspectives on most significant symptoms
The facilitated discussion provided a look into how symptoms manifest and how they have changed over
time. The range of symptoms discussed by in-person and web participants is described in more detail
below. Note that while FDA focused discussion on sexual interest and arousal symptoms to narrow the
meeting scope, this report includes the wider range of symptoms and impacts described at the meeting.
Generally speaking, participants appeared to believe that their most significant symptoms are multifaceted and broader than the six specific sexual symptoms outlined in the DSM-5.
I Sexual Interest or Desire
One participant described desire as “if you are interested in having sex or receptive to your
partner approaching you” and arousal as “when you are getting wet… tingly, when you are having the
bodily changes.” Several other participants shared similar conceptualizations. However, one participant
stressed the challenge in finding consistent, overarching terms given the significant diversity in personal
Reduction or loss of sexual interest was the most frequently discussed symptom by in-person and web
participants. Participants used the terms desire (most frequently used), interest, libido, and sexual
appetite when describing this aspect of their condition. Their comments focused on thinking about sex,
the desire to have sex, and their response to (or avoidance of) their partner’s initiation, as illustrated
• “I don’t even think about sex.”
• “I knew I wanted to have sex but I had no desire. I refrained.”
• “In a beautiful place with the man I love, my body was like a shell with nothing inside.”
• “I am able to grit through [sex], but I do it for [my partner], not for me.”
According to the results of a polling question few in-person and web
participants considered “no or reduced sexual/erotic thoughts or fantasies” to have a significant impact on daily life.
Several participants commented on the loss of their ability to become aroused. Participants used the
terms arousal, response, stimulated, sexual excitement, and becoming lubricated when describing this
aspect of their condition, as illustrated below:
• “The ability to be stimulated by being touched slowly disappeared. Sexual arousal and response
time kept taking longer and longer until it became nonexistent.”
• “It is not a matter of how much foreplay we do or not. I’ll be approached and we can spend
forever trying to make something happen.”
• “[E]ven if I’m willing when my husband initiates to have sex, I can’t stay in the moment
necessarily, and then your body stops responding.”
The facilitator and FDA panel asked a number of follow-up questions throughout the discussion for a
better understanding of patients’ experiences with sexual interest and arousal. The topics raised are
Onset of interest and arousal symptoms, and changes over time
When asked by show of hands, a few participants indicated that they have been living with their
conditions for their entire lives.
However, most participants indicated that they had acquired their
symptoms, framing their experience as a transition from a fulfilling sex life to a total loss of interest and
arousal. Some participants noted a gradual change over the course of several months or years, while for
others the change happened “like a switch that went off."
Several participants attributed the onset of their condition (either sudden or gradual) to specific life
events, including childbirth, hysterectomy or mastectomy, intrauterine device complications, early-onset
menopause, discontinuing interest and arousal.
For example, one participant commented that “as my arousal builds often
times I experience just an unbelievable migraine…so some of my low libido might just be [due
to] the fact that there is pain waiting at the end.” Another participant described the effects of
how vaginal dryness and pain affects her interest, stating that “Having sex was not at all
The pain during intercourse was excruciating. Both my desire and interest were
overshadowed by my fear of pain.” One participant, however, commented that her FSD first
manifested as a lack of desire and then progressed to include vaginal dryness.
• Anxiety: Several participants commented on the anxiety they feel when facing a sexual
encounter. Some described the loop of negative thoughts that constantly runs through their
head as they are engaged with their partners, for example wondering “am I going to be able to
orgasm during this and is that going to impact how he feels about our relationship,” or “I know
that I’m not going to be able to respond back.” Participants reported these feelings to be a
significant deterrent from having sex. In addition, when asked by FDA, about one-half of
meeting participants indicated by show of hand that they would place anxiety among the top
symptoms of FSD that have the most significant impact on daily life.
• Other symptoms, such as hot flashes, sleep disturbances, and mood swings were also
Initiation of Sex
Although not asked through polling, most in-person participants referenced having a long-term
relationship with a partner. In response to a question asked by FDA, nearly all participants indicated that
their partner is the one who typically initiates sexual activity. Participants described engaging in “duty
sex” and having sex “out of obligation.” As one participant explained, “I might not even want to have sex
but if he wants sex then and I give it to him then, yes, I was a good wife today.” A web participant
commented that “I have to pretend to enjoy for my husband otherwise he won't even approach me to
have sex. He has to know that he has pleased me and satisfied me.”
Participants also described their reluctance to engage in sexual activity and the measures they take to
avoid intimacy “at all costs.” One comment resonated with many in-person and web participants: “I
found myself avoiding any situations where a sexual experience may occur… going to bed after my
husband fell asleep or jumping out of bed in the morning before he got up just so he wouldn’t try to
initiate sex. I even found myself avoiding simple hugs and kisses.”
Overall impact of female sexual dysfunction on daily life
Participants throughout the meeting described the larger impact sexual interest and arousal symptoms
have on their lives and the lives of their partners and families, summarized below.
• Impact on relationships: Most participants discussed the strain that their FSD placed on their
partners and their relationships. A few participants described their partners’ reluctance to initiate
contact, because of their perceived failure to stimulate sexual response, their fear of rejection, or
their fear of causing their partner physical or emotional pain. As one participant’s partner
commented during the meeting, “It does have a huge impact when your lover, your soul mate, is no
longer interested in having sex with you.” Another participant shared that her partner “has said to
me that he feels stupid at times when he keeps getting shut down. I know he feels rejected.” Other
participants commented on relationships that have failed because of their FSD.
explained, “I lost a major relationship to this issue, and I never want to go back there.” A few
participants stressed that the negative impact of their condition affects not just relationship with
partners, but their relationships with family and friends.
• Impact on self-esteem and identity: Participants said that their loss of sexual functioning left them
with feelings of low self-esteem and inadequacy. Many noticed a drop in their levels of confidence
as it related to their sexuality, attractiveness, and femininity. One participant shared, “I had difficulty
coping with my new reality and coming to terms with the discrepancy between who I was and who I
became.” Another participant commented that her condition “affects things like my self-confidence
and how I approach the world and how I feel about myself and what I project to other people.”
• Emotional impacts: Several participants described the devastation they felt after they failed to
regain sexual function and were unable to perform in intimate situations with partners. One
participant shared, “I became so frustrated that any attempt to have sexual intercourse would end
up in me crying.” Other participants discussed the guilt their difficulties caused them to feel when
they said, “I can’t be the woman he married” and “I feel like I pulled a bait and switch with my poor
husband, who is undoubtedly wondering where the old me has run off to.” Participants also linked
the shame and stigma associated with their condition to the isolation they felt. They described being
embarrassed and reluctant to talk about their issues