Introduction Sexual expression is a broad phenomenon that is largely beyond procreation, especially in relation to the need to build trust and affection between couples. In women, this defect is quite common as up to 45% have at least one sexual dysfunction. The commonest disorder is Low Sexual Desire, with a prevalence that increases with age. Generally, a normal sexual response is only likely in a state of good health; physical and psychological. Both women are unique in that they are more likely to come forward for formal help.

Stages of human sexual response everyone possesses a biological sex drive and the stages of the sexual response arise from this drive starting from desire to arousal through orgasm to resolution. The movement from desire to orgasm is traditionally depicted as climbing upstairs. The ground floor is the non-sexual stage.

The first stage is that of desire, while the second is the onset vaginal lubrication and early arousal with penile erection in the male that is not firm enough for sexual intercourse. The third stage is a further progression of the second while the fourth is imminence of orgasm and finally orgasm itself (fifth). It is normal for both sexes to spend time going up and down some of the steps and not directly to step five.

Each individual is responsible for their orgasm and there is no need to aim for synchrony. It is important that the thought and feelings during resolution is that of fulfillment and not resentment.

Classification Sexual dysfunction could be primary when there is no known cause or secondary when it is related to other disease processes. It can also be situational or global, occurring at all times.

Sexual desire disorders: Hypoactive sexual desire, Sexual aversion and hyperactive sexual desire.

Sexual arousal disorders: Female sexual arousal disorder (FSAD)

Orgasmic disorders: Premature or delayed orgasmic disorders.

Sexual pain disorders: Dyspareunia (Pain during intercourse) and vaginismus.

Etiology Physiological causes include; Menstrual cycle, childbirth, menopause and the ageing process. Vulvar surgeries, arthritis, cardiovascular disease comprise the Organic problems. Psychosocial causes are related to lack of incorrect information about sex, sexual myths and taboos, communication problems and unrealistic expectations.

Management Sexual aversion and lack of sexual enjoyment These are usually associated with traumatic experiences such as rape and negative notions. They may be global or situation. Psychosexual therapies include; individual therapy to help discover the predisposing factors. Abuse resolution and gradual desensitization are useful alternatives. Drug treatment is mainly the use of Selective Serotonin Re-uptake inhibitors that are known to reduce the incidence of phobias.

Female sexual arousal disorders Treatment options include: behavioral modification to improve understanding and to enhance communication of sexual needs; the use of fantasy and erotic materials. Drug options are; Oral or vaginal estrogen, artificial lubricant; Sildenafil and the use of clitoral devices.

Vaginismus this involves the spasm of the muscle that surrounds the vaginal introitus (Pubococcygeus). The muscle tightens in anticipation of pain. The vaginal spasm may also be accompanied by tightening of the thigh muscles. It associated with traumatic past experiences. Treatment options include providing information about genital anatomy and female sexual response; individual therapy; gradual desensitization and vaginal dilators.

Dyspareunia this can be superficial or deep. Treatment options are; medication for vulvo-vaginitis; topical steroids for dermatitis; topical estrogen for vaginal atrophy and topical anesthetic agent. Psychosexual care is similar to that of vaginismus.