Understanding Female Sexual Problems -- Diagnosis and Treatment
How Do I Know If I Have Female Sexual Problems?
The most important way for your health care provider to diagnose a sexual problem is to listen carefully to the story you tell, review the medications and substances you use, and try to determine whether difficulties are recent, long-standing, or have been a permanent fixture thus far in your life. It's also important for your provider to try to understand how much you know about your body and about sexuality. The provider will probably encourage you to talk about the relationship with your partner, past sexual history, any history of trauma, and any other stresses or concerns that may be interfering with the ability to respond sexually. While these topics may seem extraordinarily private, they must be covered to properly evaluate sexual dysfunction and help you have a more satisfying sex life.
A thorough physical exam and basic blood tests will help determine whether a physical ailment could be causing your sexual problems. During a thorough pelvic exam, your health care provider will try to identify any possible physical sources for sexual dysfunction, such as involuntary muscle spasms around the vagina (vaginismus) or prolapse of organs into the vagina. You may be asked to use a mirror to identify the parts of your body, to determine your level of knowledge about and degree of comfort with your own body.
It is important to understand that the recognition and treatment of female sexual problems is a relatively new field. Providers vary considerably in their expertise and personal comfort in addressing these issues.
What Are the Treatments for Sexual Problems in Women?
Your health care provider may try to treat any underlying condition that might be interfering with your sexual functioning. For example, vaginal dryness after menopause may be treated with local estrogen creams, infections with antibiotics, and some conditions (organ prolapse into the vagina, anatomic defects, or abnormal healing after repair after childbirth) may require surgery. Better control of diabetes, thyroid conditions, kidney disorders, and high blood pressure may alleviate problems with sexual functioning. Low sex drive after menopause may be treated with combinations of oral estrogen and testosterone.
Postmenopausal systemic estrogen therapy should be tried first. Local hormone therapy (vaginal estrogen cream) can reestablish sensitivity and restore the ability to have an orgasm. If improvement does not occur within three to six months, testosterone may be added. Research has not established a relationship between a specific level of testosterone and diminished sexual symptoms. Androgen replacement may be considered if you've entered menopause before age 40.
Arousal problems may be difficult to resolve if you've never experienced sexual satisfaction. Therapies are designed to help the patient relax, become aware of feelings about sex, and eliminate guilt and fear of rejection.
Inadequate lubrication in a healthy, premenopausal woman may reflect either a muted sexual response or inadequate arousal by the partner. Explore feelings about sex and seek to eliminate guilt and fear of rejection. Extended foreplay, masturbation, and relaxation techniques may help. Artificial lubricants are available over the counter at any pharmacy.