In an age of chronic impatience, when popping a pill or having one outpatient procedure is the preferred answer to all ills, female sexual dysfunction (FSD) remains for many health care providers a tangled web of guessing games and supposition. There’s simply no one-size-fits-all cure, notes Shanna Staples, a licensed mental health counselor and certified sex therapist (among other related specialties) in Seaford—one of the last such providers in Sussex County.
Previously part of a collective, Staples opened her own practice in early 2024 to concentrate on Delaware’s gender-diverse population. “I had started working with some of the transgender and nonbinary individuals in lower Delaware and recognized this as an area of service lacking across the entire state. I wanted to fill that gap,” she explains, underscoring the current dearth of gender-affirming care in the state.
Staples, who received her sex-therapy certification from Widener University and is currently enrolled in its human sexuality doctoral program, believes that much of what is labeled “sexual dysfunction” is often a byproduct of individual life stages—and defined by outdated societal norms.
Although an estimated 44% of women experience FSD at some point—broadly characterized as persistent issues with sexual desire, arousal, orgasm, or pain—progress has been slow on research and treatment advances. It’s a complex, layered diagnosis with causes ranging from hormonal imbalances, medication side effects, and medical conditions like heart disease and diabetes to psychological factors and lifestyle choices.
Colleen DeTurk, Ph.D., a women’s health nurse practitioner at ChristianaCare Center for Urogynecology and Pelvic Surgery, says FSD is diagnosed by patient history and validated screening tools such as the Decreased Sexual Desire Screener or Female Sexual Functioning Index. “The patient may also need a physical exam, but not always,” she says. “Providers are [getting] better at screening patients for FSD and referring [them] to specialists. Patients are also more educated and aware of the condition and are seeking care on their own.”
Standard treatment options for FSD include medications; psychotherapy; sex counseling; physical therapy; procedures such as trigger-point injections for high-tone pelvic floor disorder; and durable medical equipment using vaginal dilators, pelvic wands, and vibrators,” DeTurk says. “Alternative therapies are the ‘O’ shot, or vaginal rejuvenation with the use of lasers and shockwave therapy.”
Whether women whitewash their symptoms and discomfort or Western medicine pushes the archaic assumption that male virility drives female sexuality, there’s still no little blue pill promising female sexual satisfaction. And that’s OK, says Staples.
As her therapeutic lens widens its focus on human sexuality—from polyamory to intentional celibacy—Staples is challenging what she calls the “medicalization” of FSD.
“People often want to go straight to drug and medical treatment when it comes to differences in sexual function,” she observes. However, a single Viagra won’t cure anxiety, depression, substance use, past trauma and abuse, or other deep-seated personal demons. Is the change in desire or potency a true dysfunction, a general misunderstanding of one’s own body, or systemic unhappiness in relationships? These are questions Staples routinely asks.
After ruling out quantifiable medical conditions, helping clients realize that sexual desire or function shifts are not categorically problematic encourages an open-eyed exploration of individual preferences for female sexual pleasure, intimacy, and performance. Techniques such as pleasure mapping, which numerically rates levels of arousal, aids clients in reconnecting with their body, discovering what pleasures them and what doesn’t, and clearly communicating those needs to partners.
The realization that there’s nothing wrong with their body—that it’s responding appropriately to the situation at that time—inspires clients to challenge preconceived expectations and obligations of what it means to be a healthy, sexually active woman. False narratives around female sexuality are many, Staples asserts. “What actually defines ideal sexual functioning is the individual,” she concurs, not penetration, lubrication, or even orgasm.
“Having a different experience of what pleasure is or what feels good to your body within your intimate relationships is not a dysfunction,” Staples concludes. Rather than viewing themselves as somehow flawed, women can work to redefine sexual success through self-awareness, greater self-confidence, and intentionality in their relationships.
Related: What You Need to Know About Maintaining a Healthy Pelvic Floor
