Sexual behavior and response is guided by a complicated mix of environment, psychology, and physical elements. Research shows that about 66% of all women have sexual concerns, including:
- Lack of desire (33%)
- Lack of pleasure in sexual contact (20%)
- Pain with vaginal penetration (15%)
- Problems with arousal (18% to 48%)
- Problems attaining climax (46%)
- Complete lack of orgasm (15% to 24%)
It can be very difficult to figure out what’s affecting your ability to enjoy your sexuality. It may take patience on the part of you, your partner, and your doctor. Sexual dysfunction can affect both sexes.
The major categories of sexual dysfunction in women include:
- Inhibited or hypoactive sexual desire: a disinterest in sexual contact or complete lack of sexual desire.
- Female sexual arousal disorder: the inability to become aroused, including lack of erotic feelings and physical signs of arousal, such as nipple erection, vaginal lubrication, and changes in blood flow to the labia, clitoris, and vagina.
- Female orgasmic disorder: the inability to have an orgasm (sexual climax) despite the ability to become sexually aroused and despite adequate sexual stimulation.
- Dyspareunia: pain with intercourse or attempted intercourse.
- Vaginismus: a disorder in which the muscles around the entrance to the vagina spasm uncontrollably, making vaginal penetration and/or intercourse painful and extremely difficult or impossible.
What Causes Sexual Problems in Women?
Because the sexual response is so complex, there are many causes of sexual dysfunction.
Misinformation or poor techniques contribute to sexual problems. Only about 1 in 3 women reach a climax regularly through intercourse alone, without additional stimulation of the clitoris. About 10% of women never achieve orgasm. But it is possible, and even common, to have a pleasurable sex life without orgasm.
Your environmental factors can interfere with your sex life. You may find it hard to perform sexually if there’s no safe, private place to relax or if you’re tired from an overly busy work and personal life. Parents may have trouble juggling intimacy with the demands and presence of their children. The complications of "safer sex" and the psychological effects of discrimination can give rise to anxieties for lesbian women.
Your sexual functioning may be affected by medical conditions such as:
- High blood pressure
- Kidney disease
- Multiple sclerosis or spinal cord injury
- Thyroid disease and other hormone disorders
- The consequences of radiation therapy for cancer
- Any other condition that causes fatigue and debilitation
- Premature menopause or removal of ovaries
Pain during intercourse (dyspareunia) may result from:
- Painful ovarian cysts
- Pain or spasm of the vaginal muscles
- Chronic pain with no known cause (vulvodynia) that affects the vulva, which includes a woman's external sex organs
- Pelvic infections
- Uterine or bladder prolapse
- Inadequate vaginal lubrication which can happen with menopause or with lack of foreplay
- Skin conditions of the vulva and vagina called lichen sclerosus
- An abnormally formed vagina (due to a birth defect, scarring from repair after childbirth, or radiation damage)
- A poor-fitting contraceptive diaphragm
- An allergic reaction to certain condoms or spermicidal jellies or foams
- Fears or anxiety
- A combination of one or more of the above conditions
A variety of medications and drugs can interfere with sexual functioning, including:
- Drugs to treat high blood pressure
- Pain medications
- Certain antidepressants
- Antipsychotic medications
Psychology may play a role, particularly if your problem is lack of desire or inability to get aroused. You may find it difficult to enjoy a sexual relationship if:
- You're under a lot of stress.
- Your relationship is troubled.
- You have a history of traumatic sexual encounters.
- You were raised in a family with strict sexual taboos.
- You have poor body image.
- You're afraid of getting pregnant or of contracting a sexually-transmitted disease.
- You have negative feelings (including guilt, anger, fear, and low self-esteem).
- You have an anxiety disorder.
- You are depressed.
When Should You Get Help for Sexual Dysfunction?
Call your doctor about sexual problems if:
- Sex has become an issue between you and your partner.
- You have no desire for sexual contact.
- You’re unable to become sexually aroused or to have an orgasm, either as a new development or as a lifelong problem.
- You have pain with intercourse or vaginal penetration.
- You’re unable to participate in intercourse or vaginal penetration because you have involuntary muscle spasms around the vagina.
Your doctor should listen carefully as you describe your problem, review the medications and substances you use, and find out whether your difficulties are recent or long-standing. They need to understand how much you know about your body and about sexuality. And you should tell them about your 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.
You’ll probably have a thorough physical exam, including a pelvic exam, and basic blood tests.
The recognition and treatment of female sexual problems is a relatively new field. There can be a lot of difference between providers’ expertise and personal comfort in addressing these issues.
What Are the Treatments for Sexual Problems in Women?
Once you and your doctor have figured out the root of your sexual problems, you can find the right treatment.
- Underlying conditions. Get treated for an infection to get rid of related pain. Better control of diabetes, thyroid conditions, kidney disorders, and high blood pressure may clear up problems with sexual functioning. You may need surgery to treat other sources of pain, like organ prolapse, scarring, endometriosis, or pelvic adhesions.
- Hormones. After menopause, hormone therapy can help with a number of problems, including vaginal dryness, low sex drive and the inability to have an orgasm. Your doctor may have you try an estrogen cream or pills with estrogen and possibly testosterone.
- Physical therapy. Kegel exercises to improve vaginal muscle tone can help improve sexual responsiveness and enjoyment. You clench the muscles that stop the flow of urine, holding for about 5 to 10 seconds, and then relax. You'll do three sets of 10 to 15 contractions daily.
- Psychotherapy. If psychological or emotional issues are causing your sex problems, you may need help from a therapist. They can help you learn to relax, become aware of your feelings about sex, and eliminate guilt and fear of rejection. They can also teach you how to better communicate with your partner about what you want sexually, and to resolve underlying conflicts.
- Sex therapy. This specialized therapy can teach you to enjoy sex without any negative feelings you may associate with it. You’ll learn exercises for relaxation, extended foreplay, and masturbation, and gradually work toward intercourse with your partner.