Sexual problems in women
Introduction
Sexual dysfunction in women encompasses a range of symptoms that can affect desire, arousal, lubrication, comfort or pleasure during intercourse. They can take the form of reduced desire, pain, blockage, apprehension or difficulty in reaching orgasm.
⚠️ These disorders are not solely psychological: they may be linked to hormonal, anatomical, urinary, hormonal or emotional causes, or to certain pelvic pathologies.
📌 A medical and functional assessment can determine the origin of the problem and propose a comprehensive treatment plan.
Symptoms and clinical forms
Here are the symptoms most frequently reported in female sexual disorders:
1️⃣ Decreased sexual desire
- Loss of interest or lasting drop in libido
- Difficulty feeling the urge, even in favorable conditions
- Fatigue, stress or associated pain
2️⃣ Pain during intercourse (dyspareunia)
- Sensations of burning, tension or tightness
- Pain on entry or deeper
- Possible link with irritation, hormonal disorder, prolapse or excessive contraction of the perineum
3️⃣ Vaginal dryness
- Insufficient lubrication, impeded penetration
- More frequent following childbirth or hormonal changes
- Source of micro-lesions and discomfort
4️⃣ Difficulty reaching orgasm (anorgasmia)
- Rare or absent orgasms despite stimulation
- Sometimes linked to muscular, nervous or psychological disorders
- May be secondary to pain or apprehension
5️⃣ Involuntary contraction or blocking of the perineum (vaginismus)
- Reflexive or involuntary tension of the perineal muscles
- Discomfort or inability to have penetrative intercourse
- Often associated with previous apprehension or pain
Causes and mechanisms
Phimosis can be caused by :
1️⃣ Bladder weakness after prostate surgery
- Radical prostatectomy, performed to treat prostate cancer, can damage urinary sphincters or the nerves controlling continence.
- Loss of anatomical or nervous support can lead to urine leakage, particularly when standing or exerting oneself.
- Post-operative incontinence may be transient (a few weeks to a few months) or persistent (beyond 6 to 12 months).
2️⃣ Involuntary loss of urine on exertion or at rest
- Stress incontinence: leakage occurs when there is an increase in intra-abdominal pressure (coughing, sneezing, carrying a load). This reflects a failure of the sphincter mechanism.
- Resting incontinence: urinary leakage unrelated to exertion, often linked to bladder hyperactivity, high bladder pressure or extrinsic support weakness.
3️⃣ Bladder control difficulties
Some incontinences are linked to disorders of the bladder itself:
- Bladder hyperactivity/urgency: sudden, irrepressible need to urinate, with risk of leakage if the man can't reach the toilet in time.
- Bladder instability: involuntary contractions of the bladder during the filling phase.
- Mixed component: a combination of a sphincter defect and bladder overactivity.
What are the symptoms?
Symptoms may vary depending on the type of incontinence:
- Frequent urine leakage, sometimes in small quantities
- Delayed drops after micturition
- Urinary bags or pads to prevent leakage
- Need to urinate more frequently, urgent urges
- Inability to hold urine before reaching the toilet
- Psychosocial impact: discomfort, social awkwardness, isolation, sleep disorders
The repercussions are often significant: loss of confidence, limited activity, frequent recharging of protective gear.
Diagnosis
To properly treat urinary incontinence, a complete evaluation is essential:
1️⃣ Detailed medical history
- Date of onset of leaks
- Time and circumstances (exertion, rest, emergency)
- Previous prostate surgery
- Aggravating factors (obesity, chronic cough, constipation)
2️⃣ Physical examination
- Perineum examination
- Palpation and test of perineurethral mobility
- Verification of prostate condition
3️⃣ Supplementary balance sheet
- Urodynamic assessment: measurement of bladder and urethral pressures, study of leaks
- Cystoscopy: if urethral lesion suspected
- Vesico-post-micturition ultrasound: assessment of post-micturition residue
- Voiding diary / pad test : quantifying leakage
📌This investigation makes it possible to differentiate mechanisms (sphincter, bladder, mixed) and adapt treatment.
Possible treatments
Treatment depends on mechanism, severity, duration and impact on quality of life.
1️⃣ Conservative approaches
- Perineal rehabilitation / physiotherapy
- Electrical stimulation or biofeedback
- Hygienic dietary measures : limit beverages, avoid constipation, control weight
- Medication (in certain cases) : anticholinergics, beta-3 agonists, etc.
- Management of thebladder component (in emergency incontinence)
2️⃣ Medical devices
- Urethral prostheses: devices designed to ensure artificial continence
- Urethral balloons
- Peri-urethral suspension
3️⃣ Surgical treatments
- Urethral slings to support the sphincter
- Artificial Urinary Sphincter (AUS) prosthesis: reference solution for moderate to severe leakage, particularly after prostate surgery
- Injection of substances into the urethra (glues, volumizing agents) in very mild cases
- Associated bladder correction (if hyperactivity)
📌Each option has its own indications, advantages and constraints. The choice must be discussed with the patient based on the assessment, age, comorbidities and expectations.
Why consult Pr Haab?
- With over 30 years' experience in urological surgery and incontinence management, Prof. Haab offers a personalized, step-by-step approach.
- He first favors the gentlest treatments before considering more invasive procedures (rehabilitation, minimally invasive techniques).
- If surgery is required, he masters the techniques of applying slings, artificial sphincters and other modern solutions.
- The aim is to restore continence, improve comfort and restore patient confidence.
Do you have intimate problems?
Requirements
Expertise
Patient pathway
Each patient benefits from personalized support, from the first consultation to post-treatment follow-up. This includes a precise assessment, a clear presentation of the different treatment options and a progressive approach to treatment, tailored to each patient’s individual situation.
Do you suffer from urinary incontinence?
Do you suffer from urinary incontinence and need specialist advice?
Professor François Haab consults in Paris and accompanies you every step of the way, with scientific rigor and human kindness.
📍 Cabinet Urologie Paris Opéra – Paris 17th
📅 Face-to-face consultation or teleconsultation
📞 Book an appointment today
