It is of interest that women have just as many sexual problems as men. In the past 15 years, more attention has been given to male sexual problems, mostly erectile dysfunction, as medications have been available for treating this common condition. Now women with decreased desire, decreased lubrication, decrased aroiusal, and lack of orgasm can now be treated.
What Causes Sexual Dysfunction?
Sexual dysfunction in women can be a result of a physical andor psychological problem.
Physical causes. Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart disease, neurological diseases, hormonal imbalances, menopause plus such chronic diseases as kidney disease or liver failure, and alcoholism or drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.
Psychological causes. These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, or the effects of a past sexual trauma.
The most common problems related to sexual dysfunction in women include:
- Inhibited sexual desire. This involves a lack of sexual desire or interest in sex. Many factors can contribute to a lack of desire, including hormonal changes associated with menopause, medical conditions and treatments (for example, cancer and chemotherapy), depression, pregnancy, stress, and fatigue. Boredom with regular sexual routines also may contribute to a lack of enthusiasm for sex, as can lifestyle factors, such as careers and the care of children.
- Inability to become aroused. For women, the inability to become physically aroused during sexual activity often involves insufficient vaginal lubrication. This inability also may be related to anxiety or inadequate stimulation.
- Lack of orgasm. An absence of orgasm can be caused by a woman’s sexual inhibition, inexperience, lack of knowledge, and psychological factors such as guilt, anxiety, or a past sexual trauma or abuse. Other factors contributing to an absent orgasm include insufficient stimulation, certain medications, and chronic diseases.
- Painful intercourse. Pain during intercourse can be caused by pelvic organ prolapse, endometriosis, a pelvic mass, ovarian cysts, vaginitis, poor lubrication, the presence of scar tissue from surgery, or a sexually transmitted disease. A condition called vaginismus is a painful, involuntary spasm of the muscles that surround the vaginal entrance. It may occur in women who fear that penetration will be painful and also may stem from a sexual phobia or from a previous traumatic or painful experience.
The diagnosis of female sexual dysfunction begins with a physical exam and a thorough evaluation of symptoms. The doctor performs a pelvic exam to evaluate the health of the reproductive organs and a Pap smear to detect changes in the cells of the cervix (to check for cancer or a pre-cancerous condition).
An evaluation of your attitudes regarding sex, as well as other possible contributing factors (such as fear, anxiety, past sexual trauma/abuse, relationship problems, or alcohol or drug abuse) will help the doctor understand the underlying cause of the problem and make appropriate treatment recommendations.
Treatment of Female Sexual Dysfunction
Most types of sexual problems can be corrected by treating the underlying physical or psychological problems which include:
Providing education. Education about human anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and appropriate responses, may help a woman overcome her anxieties about sexual function and performance.
Enhancing stimulation. This may include the use of erotic materials (videos or books), masturbation, and changes in sexual routines.
Providing distraction techniques. Erotic or non-erotic fantasies; exercises with intercourse; music, videos, or television can be used to increase relaxation and eliminate anxiety.
Encouraging non-coital behaviors. Non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage, can be used to promote comfort and increase communication between partners.
Minimizing pain. Using sexual positions that allow the woman to control the depth of penetration may help relieve some pain. Vaginal lubricants can help reduce pain caused by friction, and a warm bath before intercourse can help increase relaxation.
The success of treatment for female sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.
Hormones play an important role in regulating sexual function in women. With the decrease in the female hormone estrogen that is related to aging and menopause, many women experience some changes in sexual function as they age, including poor vaginal lubrication and decreased genital sensation. Low levels of the male hormone testosterone also contribute to a decline in sexual arousal, genital sensation, and orgasm. Women can use a topical gel containing testosterone or receive a small pellet of testosterone, the size of a grain of rice, placed under the skin which can result in enhancement of their libido and sex drive.
Many women experience changes in sexual function after a hysterectomy (surgical removal of the uterus). These changes may include a loss of desire, and decreased vaginal lubrication and genital sensation. These problems may be associated with the hormonal changes that occur with the loss of the uterus. Furthermore, nerves and blood vessels critical to sexual function can be damaged during the surgery.
The loss of estrogen following menopause can lead to changes in a woman’s sexual functioning. Emotional changes that often accompany menopause can add to a woman’s loss of interest in sex and/or ability to become aroused. Hormone replacement therapy (HRT) or vaginal lubricants may improve certain conditions, such as loss of vaginal lubrication and genital sensation, which can create problems with sexual function in women.
I think it is important to mention that some postmenopausal women report an increase in sexual satisfaction. This may be due to decreased anxiety over getting pregnant. In addition, postmenopausal woman often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.
Bottom Line: Many women experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the women and her partner, and can have a negative impact on their relationship. If you consistently experience these problems, see your doctor for evaluation and treatment.
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