Many sexual problems can be managed when you understand what is causing them. Effective management requires a high level of comfort between you and your health professional, and possibly your partner.

Because a sexual problem often has multiple causes, treatments cannot be universally applied-what works for one woman may not work for another. An effective plan will address and manage the cause and then build and strengthen intimate communication between you and your partner. The best results will help you find methods of having a satisfying sexual life.

Treatment may include:

• Medical treatment for any underlying cause.
• Education about your body, your sexual signals and receptors, and changes in sexuality as you get older.
• Communication counseling for you and your partner.
• Psychological therapy.
• Sex therapy.

Treatment for decrease of sexual desire

A decrease in your level of desire might be expressed by fewer sexual thoughts and/or a reluctance to engage in sexual activity. Treatment for physical causes can include:

• Changing from a medicine that has been curbing your interest in sex.
• Relieving pain, illness, or sleep problems that are curbing your interest in sex.
• Hormone therapy with estrogen. After menopause, low levels of estrogen in the body cause vaginal dryness. This can be painful during sex. Estrogen reverses this.
• Testosterone with estrogen. Normally, a woman's testosterone slowly declines with age. It drops suddenly when a woman has surgery to remove the ovaries (oophorectomy, causing surgical menopause). Testosterone with estrogen is sometimes used after natural or surgical menopause to improve sex drive. When taken in too high a dose, testosterone causes male-type side effects, such as a deepening voice, thinning scalp hair, and growth of facial and body hair. Testosterone risks are not fully researched.
• Exercise, to improve your mood and increase natural testosterone levels.

Your doctor can treat physical or hormonal causes, and you can work on other facets of sexual desire. For example:

• Changing your setting and routine can improve your time together. Do you have enough privacy and time? Are you interested in trying something new?
• Having a partner you feel comfortable and nonstressed with plays a big part in your desire level.
• Getting counseling as a couple can help strengthen your emotional connection with your partner. Improving a stressed relationship is likely to improve your sexual relationship.
• It is normal to lack desire for a partner who forces sex or is verbally abusive or physically violent. For more information, see the topic Domestic Violence.

Treatment for decrease of sexual arousal

A decrease in the level of arousal might be noticed as an inability to feel or maintain sexual excitement. A woman's sexual arousal often is enhanced by, and is sometimes dependent on, stimulation in areas other than the genital area, especially the breasts. Treatment for a decrease in your sexual arousal may include:

• Increasing the level of intimacy and sexual arousal with your partner before penetration.
• Liberal use of vaginal lubricants.
• Masturbation, possibly with the aid of a vibrator and/or with your partner.
• Education about the role that emotions play in sexual arousal.
• Counseling, to help adjust expectations of sexual activity. If too much pressure is put on partners to perform, arousal may be reduced.
• Medicine or treatment changes for other conditions, if needed to eliminate side effects that decrease arousal.

Treatment for an inability to reach orgasm