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Understanding Female Sexual Problems -- Diagnosis and Treatment

What Are the Treatments for Sexual Problems in Women? continued...

For an inability to achieve orgasm, communicating with your partner about your desires for sexual foreplay and intercourse is an essential first step toward satisfaction. Psychotherapy may help improve communication skills and help resolve underlying conflicts about sexuality. With therapy and a supportive partner, the improvement rate is good.

For pain during intercourse, first make sure there is adequate stimulation and lubrication. A physical exam may reveal a need for medication to treat infection. Or it may be necessary to remove scars around the hymen or gently stretch painful scars at the vaginal opening. Laparoscopic surgery to relieve “deep pain” can often treat endometriosis and pelvic adhesions. Problems related to menopausal change may be relieved with postmenopausal hormone therapy. If pain persists, psychotherapy may help uncover hidden fears about intercourse. Certain exercises -- called sensate focus exercises -- can teach appropriate foreplay and de-emphasize intercourse until both partners are ready. Education can reduce fears of pregnancy or of harm to the fetus.

Vaginismus is difficult to reverse without professional help. If you have a partner, seek therapy together in a safe and supportive environment. To accustom your body to the feeling of penetration, a therapist may recommend inserting a series of vaginal dilators, each slightly larger than the last. You advance at your own pace until you are comfortable inserting a dilator the size of your partner's erection. Contraction and relaxation exercises can teach control of the vaginal muscles and increase sexual responsiveness.

Kegel exercises to improve vaginal muscle tone can help improve sexual responsiveness and enjoyment. These exercises involve clenching those muscles involved in stopping the flow of urine, holding for about five to 10 seconds, and then relaxing. You're usually asked to do three sets of 10 to 15 contractions daily. Frequently, consultation with a physical therapist skilled in treating pelvic muscle problems can improve the success when treating problems arising from the muscles around the vagina. 

Sex therapy treatment may include exercises that ask you to participate in sexually stimulating behaviors, initially avoiding genital contact. You are asked to concentrate on the pleasurable sensations, simultaneously attempting to relax and ward off negative feelings, such as anxiety, fear, or guilt. When you can do this, you are then given instructions on how to masturbate.

The goal is to learn how to derive pleasure from self-stimulation without allowing negative feelings to interfere. When you are comfortable with these acts and can participate in them without negative feelings or pain, you'll be asked to begin to include your partner. Slowly, gradually, and progressively, you and your partner move towards increasing sexual intimacy, perhaps ultimately including vaginal penetration.

WebMD Medical Reference

Reviewed by Nivin Todd, MD, FACOG on March 21, 2014

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