Female Sexual Dysfunction: Beyond Libido, Shame and Silence

A more honest conversation about desire, arousal, pain, pelvic health, hormones, trauma, consent and the nervous system.

What if we were in the pub or a busy coffee shop, a group of us chatting about family, life , work and then one of us leans in and says, with almost a whisper and a sadness in the tone of her voice.

:“I don’t know what’s happened to me. I just don’t feel like sex anymore.”

And instead of everyone gasping or making a joke, another one of us says:

“Same.”

Then another says:

“I thought it was just me.”

And suddenly the whole conversation does an about change and we dig deep and really talk to each other.

Because this is the bit we don’t talk about enough in society. Not in a real way. Not in a kind way. Not in a way that makes women feel safe rather than ashamed.

Female sexual dysfunction, or FSD, is the term used when a woman experiences ongoing and distressing difficulties with desire, arousal, orgasm, or pain during sex.

But before we go any further, let’s get something very clear.

Low desire on its own is not automatically a disorder and not wanting sex all the time is absolutely not a disorder!

Having a different libido from your partner is not automatically also not a disorder.

Going through a phase where sex feels less important is not automatically something that needs to be fixed.

The key word here is distress.

If you feel absolutely fine, safe, happy, connected, and at home in yourself, then you do not need someone slapping a label on you because your desire does not match someone else’s expectation of what your desire should be!

But if your sexual health is causing you distress, pain, sadness, fear, shame, avoidance, disconnection, relationship strain, or a sense that you no longer recognise your own body, then you deserve real honest to goodness support.

Without judgement.

Without pressure.

Just proper support.

So what actually is female sexual dysfunction?

Female sexual dysfunction is usually grouped into different areas.

There can be desire difficulties, where interest in sex feels reduced or sometimes totally absent.

There can be arousal difficulties, where your mind, body, or genitals do not respond in the way they used to. This might mean less lubrication, less sensation, or feeling disconnected from pleasure.

But arousal difficulties are not always about “not enough”. Sometimes the problem is too much, too often, or completely unwanted.

And arousal is not always pleasure

When we talk about sexual dysfunction, people often assume we mean not enough desire, not enough arousal, not enough orgasm.

But there is another experience that can be deeply distressing: feeling constantly, persistently or intrusively aroused when you do not want to be.

This is sometimes called Persistent Genital Arousal Disorder, or PGAD.

And it is absolutely not the same as having a high libido. It is not the same as feeling turned on.

It is definitely not a “lucky you” situation, it can be highly distressing, uncomfortable and painful.

For some people, it can feel like unwanted genital pressure, throbbing, tingling, sensitivity, congestion, pain, or the feeling of being on the edge of orgasm without desire, pleasure, or emotional connection. It may last for hours, days, or longer. It may not fully settle after orgasm. And it can become frightening, exhausting, embarrassing and isolating.

This matters because arousal is not only psychological. It is also nerves, blood flow, pelvic floor tone, tissue sensitivity, medication, spinal health, stress, trauma, and the nervous system.

So if your body feels constantly aroused but you do not want sex, that does not mean you are strange, greedy, oversexual, or making it up.

It means your body may be stuck in a distressing sensory or nervous system pattern that deserves proper support. You deserve to be taken seriously.

And this is one of the places where shame can do real damage. Because people may not tell anyone. They may fear being judged, laughed at, sexualised, or dismissed. But persistent unwanted arousal is not a joke. It can be truly awful.

Support may need to include a GP, sexual health clinician, pelvic health physiotherapist, psychosexual therapist, pain specialist, neurologist, or medication review, depending on what is driving the symptoms. I have had clients that have had great success using a combination of Hypopressives and mindset work. But I always advise working with a team to also pinpoint the why and the how. Sometimes it has been post a thrush attack and others post a huge life challenge.

And again, the answer is not to force the body.

It is to listen carefully, reduce shame, assess properly, and support the whole system.

There can also be orgasm difficulties, where orgasm feels delayed, muted, unreachable, or frustrating.

And there can be pain. Pain with penetration. Pain with touch. Pain afterwards. Pain that makes your whole body brace before anything has even happened.

And here’s the bit I really want you all to understand.

These things rarely happen in isolation.

Sexual function is not just about hormones. It is not just about the vagina. It is not just about your relationship. It is not just about your pelvic floor.

It is your nervous system, your tissues, your blood flow, your breath, your hormones, your history, your stress load, your sense of safety, your body image, your sleep, your medication, your relationship dynamics, your pelvic floor, and whether your body feels like a place you want to come home to.

That is not simple.

And that is exactly why “just have a glass of wine” or “just relax” is such useless advice. And was the advice I was given by a doctor along with pour a bath and put lavender in it.

Desire is not a switch

We have been sold a very narrow version of desire.

The film version.

The spontaneous version.

The “one look across the kitchen and suddenly you’re ripping each other’s clothes off” version.

And yes, spontaneous desire exists. And if this is your story, don’t change a thing! Go for it! And enjoy every delicious second!

But many women experience desire differently, especially after childbirth, during perimenopause, after trauma, during stress, when exhausted, or when their relationship has become more functional than sensual.

For many women, desire is responsive.

It arrives after safety.

After warmth.

After being touched in a way that does not demand anything.

After the nervous system stops scanning the room.

After the body really believes there is no pressure.

After the brain stops thinking about packed lunches, ageing parents, work messages, the washing, the dog, the shopping, the pelvic heaviness, and whether someone is going to expect sex because they were nice to you earlier (even if they were just loving you and wanting you to be okay).

This is something really close to my heart because for about 7 years after the birth of my boys this was me. And my gorgeous, funny, caring husband thought it was him. He thought I had fallen out of love with him. That I didn’t find him attractive anymore. That we would lose that connection that we had had in abundance before kids.

And Honestly, if we are going to talk about female desire, we need to talk about load, because (along with the image of my pelvic floor that I had seen in the mirror that looked like a horror show.) There was so much other load.

Not just pelvic load.

Life load.

Emotional load.

Mental load.

Physical load.

The invisible list that women carry in their bodies.

Because a body that feels hunted, hurried, criticised, exhausted, or obligated is not usually a body that opens easily to pleasure.

For some the load, the nervous system, trauma, life experiences bring pain.

Pain changes everything

Painful sex is not something to push through.

Let me say that again.

Painful sex is not something to push through.

If penetration hurts, if your body clamps, if you feel burning, tearing, bruising, stinging, sharp pain, deep ache, or fear before sex, your body is telling you something.

That does not mean sex is over forever.

It means your body needs listening to.

Pain can come from hormonal changes, especially around breastfeeding, perimenopause, and menopause, when lower oestrogen can affect the tissues of the vulva, vagina, bladder, and urethra.

The tissues may become drier, thinner, less elastic, more sensitive, or more prone to irritation. And when sex becomes uncomfortable, the pelvic floor may start guarding to protect you.

That guarding can become a loop.

The tissues feel sore.

The nervous system becomes protective.

The pelvic floor tightens.

Penetration feels harder.

Pain increases.

The body learns to brace earlier next time.

And before long, you are not “just a bit tense.”

You are in a protective pattern.

This is where pelvic floor work can be so important. But not the “squeeze harder” kind. For many women with pain, the pelvic floor does not need more gripping.

It needs safety.

It needs release.

It needs coordination.

It needs breath.

It needs the whole body to stop dumping pressure and protection into one small area. But before we look at what we can do we have a few more topics to look at first…

We need to talk about female genital mutilation too

There is another part of this conversation that has to be named with care: female genital mutilation, or FGM.

FGM is when the female genitals are deliberately cut, injured, or changed for non-medical reasons. It is illegal in the UK and it is recognised as a form of abuse. But for women and girls living with the impact of it, this is not just a legal or cultural issue. It is a body issue. A safety issue. A pain issue. A trust issue. A sexual health issue.

FGM can affect sexual function in many ways.

It may cause pain with touch, pain with penetration, difficulty with arousal, reduced sensation, scar tissue sensitivity, fear, pelvic floor guarding, urinary symptoms, menstrual difficulties, childbirth complications, and trauma responses. Some women may also carry deep shame, grief, anger, numbness, anxiety, or disconnection from their body.

And this is where we have to be very clear.

A woman who has experienced FGM does not need to be treated like a problem.

She needs to be treated with dignity, consent, patience, and specialist support.

No forcing.

No assumptions.

No “just relax.”

No rushing into pelvic floor work without understanding the history, the tissues, the trauma, and the nervous system.

For some women, specialist medical care may be needed. For others, pelvic health physiotherapy, trauma-informed therapy, sexual health services, or psychosexual support may form part of the picture.

And for some women, the first step is simply having someone safe enough to say it to. Like we are in the coffee shop/pub together just now, or that’s where I am in my head as I write this.

If FGM is part of your story, you absolutely deserve proper support from professionals who understand both the physical and emotional impact. You are not damaged. Your body may have been hurt, guarded, silenced, or made unsafe, and you deserve care, choice, comfort, pleasure, and ownership of your body.

A note on male circumcision

This is also the point where people may ask about male circumcision.

It is not the same conversation as FGM, and I do not want to blur those lines. Female genital mutilation is illegal in the UK and is recognised as abuse. Male circumcision sits in a different legal, medical, cultural and religious context.

But it is still worth mentioning because any change to genital tissue can affect how someone experiences their body, their sensitivity, their confidence, and their sexual story.

Some men are circumcised for medical reasons, such as recurrent infection, phimosis, or problems with the foreskin. Some are circumcised for religious or cultural reasons. Some feel completely fine about it. Some feel neutral. Some feel it improved comfort or hygiene. And some feel grief, anger, reduced sensation, scar sensitivity, or a sense that a choice was made about their body before they could consent.

That does not mean every circumcised man will have sexual dysfunction. The research is not that simple. Some studies show little or no overall difference in sexual function, satisfaction, or pleasure, while health services also acknowledge that reduced sensitivity can happen for some men.

So again, the point is not to make sweeping statements as someone outside of the body that has had the experinence. It is instead to listen to the man in front of us, perhaps he’s sitting at our table too.

Genitals are not just anatomy. They are sensation, memory, identity, safety, consent, pleasure, and sometimes loss.

And whether we are talking about women, men, birth, surgery, trauma, menopause, pain, or cultural practices, the same truth keeps coming back:

The body deserves respect.

The person deserves choice.

And sexual health should never be reduced to performance.

The pelvic floor is part of your sexual system

We often talk about the pelvic floor as if its only job is to stop leaking, prolapse and smearing.

But the pelvic floor is deeply involved in sexual sensation, blood flow, arousal, orgasm, pelvic organ support, pressure management, and the feeling of safety or threat in the pelvis.

If the pelvic floor is too tense, it may struggle to allow comfortable penetration.

If it is under-responsive, you may feel reduced sensation or less connection.

If it is poorly coordinated, you may feel disconnected from arousal or orgasm.

And if your whole system is bracing like your - jaw, ribs, diaphragm, glutes, inner thighs, belly, breath - your pelvic floor always joins in.

This is why I always look beyond the pelvic floor and we should all look beyond it to start, become more aware of the whole system.

What is the jaw doing?

How are the ribs moving?

Can the breath reach the back and sides of the body?

Is the diaphragm moving well?

Are the hips sharing load?

Are the feet connected to the ground?

Is the nervous system settled enough, does it feel safe enough to allow pleasure?

Because pleasure requires a certain amount of safety.

You cannot shame a body into opening.

You cannot force a pelvic floor into softness.

And you cannot squeeze your way into desire if your nervous system is screaming no.

Hormones matter, but they are also not the whole story

Hormones absolutely matter.

Oestrogen changes can affect tissue quality, lubrication, comfort, urinary symptoms, and sexual sensation.

Testosterone can be part of the libido picture for some women.

Thyroid health, diabetes, cardiovascular health, neurological conditions, fatigue, pain, and medication can all play a role too.

Antidepressants, especially some SSRIs, can affect libido and orgasm. Blood pressure medication, antihistamines, and other medicines may also influence sexual response.

So no, it is not “all in your head.”

But also, it is not never in your head in the first place!

Your brain, emotions, memories, stress levels, trauma history, body confidence, and relationship dynamics are not separate from your body.

They are your body.

This is why support always needs to be layered.

A GP or menopause-informed clinician may help with hormones, vaginal oestrogen, medication review, pain, infections, or medical causes.

A pelvic health physiotherapist, or pelvic floor specialist (like me) may help with pelvic floor tone, scar tissue, pain, tissue sensitivity, and coordination.

A psychosexual therapist or counsellor may help with desire, pressure, trauma, shame, communication, and rebuilding intimacy.

And movement, breathwork, Hypopressives, TRE, and somatic work can help women and men reconnect with the body in a way that feels safe, curious, and non-demanding.

Not because they are magic pills. I wish I could give you a magic pill!

Because they give the body new options.

What I see again and again

In my work, I often meet women who are not actually disconnected from sex. They are actually disconnected from themselves.

They are tired.

They are tense.

They are scared of leaking.

They feel heavy or uncomfortable in their pelvis.

They avoid movement because they do not trust their body.

They feel guilty for not wanting sex.

They feel damaged because penetration hurts.

They feel ashamed because their body has changed after birth, surgery, menopause, trauma, or stress.

And somewhere along the way, pleasure became another stressor.

Another thing to get right.

Another thing to feel bad about.

And reading this list back as I do my final pass over this blog before sending it out to you all, I think I was probably all of these 😢.

But your body is not a machine.

It is not there to perform on demand.

It is a living, breathing, responsive system.

And when that system has been under stress for long enough, it may protect you by closing down, numbing, tightening, avoiding, or withdrawing desire.

I used to think my body had let me down, a trap so many of us fall into. It's time to shift that paradigm. Let’s view this not as a defeat, but simply as a temporary setback

It is information. Information that we can use to make a difference- but only if we look at the whole of you, your life, your stressors, your body, your world.

And this is not only a women’s issue

Although this blog is about female sexual dysfunction, it is worth saying this clearly: pelvic floor dysfunction is not only a women’s issue.

Men have pelvic floors too. Many men don’t realise this. Between us, I have spoken to many men who when I say that I am a pelvic floor specialist often say “oh, right not something for me then”. But yes guys - you definately do have a pelvic floor!!

And when the male pelvic floor becomes too tense, poorly coordinated, weak, over-protective, or disconnected from breath and posture, it can affect sexual function, bladder control, bowel function, pelvic pain, erections, ejaculation, and confidence.

For men, pelvic floor dysfunction may show up as pelvic pain, testicular pain, pain after ejaculation, urinary urgency, leaking after peeing, constipation, erectile difficulties, premature ejaculation, difficulty fully relaxing, or a constant sense of gripping through the pelvis, glutes, belly, or jaw.

And just like with women, the answer should not immediately be “squeeze harder.”

Sometimes the male pelvic floor needs strength.

Sometimes it needs release.

Sometimes it needs better timing.

Sometimes it needs the diaphragm, ribs, hips, feet, spine and nervous system to come back into the conversation.

This is where Hypopressives can be such a useful tool, yes for men too!

Hypopressives are not just about pulling the belly in or creating a dramatic rib flare. Done well, they are about posture, breath, pressure management, rib mobility, nervous system regulation, and reflexive pelvic floor coordination.

For men, that can mean learning how to stop bracing through the abdomen, glutes and pelvic floor. It can mean improving how pressure moves through the body. It can mean working on breath mechanics and reconnecting the pelvic floor with the breath rather than treating it like an isolated muscle that just needs more effort.

And for anyone dealing with sexual dysfunction, pelvic pain, prolapse, leaking, heaviness, urgency, postnatal changes, menopause changes, erectile changes, or confidence issues, this bigger view matters.

Because sexual health is rarely about one muscle.

It is about the whole system.

Breath.

Posture.

Stress.

Blood flow.

Tissue health.

Hormones.

Nerves.

Pelvic floor coordination.

Pressure.

Safety.

Trust.

And the ability to feel at home in your body again.

What can help?

Start by taking the pressure off.

Not forever. Not in a dramatic way. Just enough to let your body stop bracing.

If sex has become painful, avoid pushing through penetration and seek proper support. Pain teaches the nervous system to protect harder.

If dryness or tissue sensitivity is part of the picture, speak to your GP, pharmacist, pelvic health physio, or menopause specialist about lubricants, moisturisers, and whether vaginal oestrogen may be appropriate for you.

If your desire has suddenly changed, especially alongside fatigue, low mood, medication changes, pain, menstrual changes, or menopause symptoms, it is worth checking in medically.

If the issue is relational, emotional, or linked to pressure, resentment, trauma, or communication, psychosexual therapy can be incredibly helpful.

And if your body feels tense, guarded, numb, disconnected, or hard to inhabit, start there.

Before you chase desire, rebuild safety.

Before you force intimacy, rebuild connection.

Before you judge your body, listen to what it has been trying to say.

That might look like gentle breathwork.

Softening the jaw.

Feeling the back ribs move.

Releasing the belly without collapsing.

Letting the pelvis move again.

Working with Hypopressives to improve pressure, posture, and reflexive pelvic floor function.

Using TRE®️ or somatic movement to discharge stored tension.

Exploring touch without expectation.

Coming back to pleasure as sensation, not performance.

Warmth.

Breath.

Texture.

Movement.

Safety.

And most definitely choice.

A different conversation

So back to the pub/coffee shop

What if our conversation sounded like:

“I don’t know what’s happened to me. I just don’t feel like sex anymore.”

And instead of everyone gasping or making a joke, another one of us says:

“What has your body been holding on to and why?”

“What has changed?”

“What feels safe?”

“What feels pressured?”

“What do you need support with?”

“What would help you feel like yourself again?”

The research studies say “While there is no single universal timeline, healthcare studies reveal that women delay seeking help for sexual dysfunction for an average of 1 to 5 years, with many waiting significantly longer or never seeking care at all. “

We need help and advice that honours the whole system. So we can share this with our friends, daughters and granddaughters - we need to address the whole issue.

The tiredness.

The hormones.

The pelvic floor.

The nervous system.

The relationship.

The scars.

The stress.

The grief.

The desire that might still be there, buried under a body that has been holding too much for too long.

You are not damaged goods. but you may be under-supported, you may be protecting, your body may be going through a change.

You may also need medical help, pelvic floor support, therapy, better communication, more rest, more safety, more education, or simply permission to stop pushing harder and start listening.

And that is not the end of intimacy.

For many women, it is the beginning of a much more honest relationship with their body.

One built not on pressure.

But on trust and open honesty.

And from there, pleasure has somewhere safer to return to.

Resources and further reading

If this blog has brought anything up for you, please know that you do not have to work it out alone. Sexual health is health. Pelvic health is health. Pain, low desire, numbness, fear, leaking, heaviness, erectile changes, orgasm changes, menopause symptoms, trauma responses and body disconnection are all valid reasons to seek support.

Medical and sexual health support

NHS: Loss of libido
Helpful if you are experiencing a reduced sex drive and want to understand possible causes such as stress, relationship difficulties, menopause, mental health, tiredness, medication or physical discomfort.

NHS: Vaginal dryness
Useful if sex feels uncomfortable, sore, dry, burning or irritating. It covers common causes and treatment options such as lubricants, moisturisers and medical support.

NHS: Vaginal oestrogen
Useful for women in perimenopause, menopause, post-menopause, breastfeeding or other low-oestrogen states where tissue changes may be affecting comfort, bladder symptoms or sexual function.

NHS: Menopause and perimenopause treatment
Includes information on HRT, vaginal oestrogen and testosterone, which may be appropriate for some women with low libido linked to menopause.

Your GP, sexual health clinic or gynaecologist
Please seek medical advice if you have sudden changes in sexual function, bleeding, new pain, recurrent infections, pelvic pain, urinary symptoms, menopausal symptoms, medication concerns, erectile changes, ejaculation changes or anything that feels worrying or persistent.

Pelvic health and psychosexual support

Pelvic health physiotherapy
A pelvic health physiotherapist can assess pelvic floor tone, coordination, pain, scar tissue, prolapse symptoms, bladder and bowel symptoms, pelvic guarding and sexual pain. This is especially important if pain is present, because the answer is not always “strengthen” or “squeeze harder.”

COSRT: College of Sexual and Relationship Therapists
COSRT is a UK professional body where you can search for registered psychosexual and relationship therapists. This can be helpful for pain with sex, desire differences, orgasm difficulties, erectile issues, trauma, shame, relationship strain or rebuilding intimacy after illness, birth, surgery or menopause.

Persistent Genital Arousal Disorder / Genito-Pelvic Dysesthesia
Persistent unwanted genital arousal is not the same as high libido. It can involve intrusive genital sensations, pressure, throbbing, tingling, pain, or the feeling of being close to orgasm without desire or pleasure. It can be very distressing and deserves proper medical and pelvic health support.

Female genital mutilation support

NHS: Female genital mutilation
The NHS explains that FGM is when the female genitals are deliberately cut, injured or changed for non-medical reasons. It is illegal in the UK and specialist support is available.

GOV.UK: Female genital mutilation help and advice
Government information on FGM, legal protection, safeguarding and where to get help.

If you or someone you know is at risk of FGM, or has experienced FGM, please seek specialist medical and safeguarding support. If a child is at immediate risk, contact emergency services.

Male circumcision and sexual health

NHS: Circumcision
Information on circumcision, why it may be carried out, possible risks and recovery. The NHS notes that circumcision can lead to loss of sensitivity for some men.

Research on circumcision and sexual function
The evidence is mixed and should be spoken about carefully. Some reviews report no consistent negative effect on sexual function, sensitivity or satisfaction overall, while individual men may still experience reduced sensation, scar sensitivity, grief, anger or distress around consent and body ownership.

Research and background reading

Female sexual dysfunction review
The research review used for this blog describes female sexual dysfunction as multifactorial, involving anatomical, psychological, physiological and social-interpersonal factors. It also discusses desire, arousal, orgasm and pain difficulties, and highlights that female sexual dysfunction has historically been less researched than male erectile dysfunction.

The importance of distress
Low desire is not automatically a disorder. A key point in both clinical discussion and lived experience is whether the person feels distress, harm, disconnection, pain or loss of quality of life. If low desire does not bother you, it does not need to be pathologised.

Recommended book
The Pleasure Gap by Katherine Rowland is a useful wider read on women’s pleasure, desire, culture, medicine and the way female sexuality has often been misunderstood or under-supported.

A final note

This blog is for education only and is not a substitute for medical advice. Please speak to a qualified healthcare professional if you are experiencing pain, distress, bleeding, sudden changes in sexual function, pelvic symptoms, trauma responses, menopause symptoms, urinary or bowel symptoms, or concerns about medication.