Sexual Problems in Women

Sexual Problems in Women

Topic Overview

Date updated: April 07, 2006
Kathe Gallagher, MSW; Merrill Hayden
Content provided by Healthwise

What are sexual problems?

A sexual problem means that sex is not satisfying or positive for you. In women, common sexual problems include feeling little or no interest in sex, having problems getting aroused, or having trouble with orgasm. For some women, pain during intercourse is a problem.

Most women have a sexual problem at one time or another. For some women, the problem is ongoing. But your symptoms are only a sexual problem if they bother you or cause problems in your relationship.

There is no "normal" level of sexual response—it is different for every woman. You may also find that what is normal at one stage of your life changes at another stage or age. For example, it's common for an exhausted mother of a baby to have little interest in sex. And it's common for both women and men to have less intense sex drives as they age. This is linked in part to hormone changes in the body.

What are some causes of sexual problems in women?

Female sexuality is complex. At its core is a need for closeness and intimacy. Women also have physical needs. When there is a problem in either the emotional or physical part of your life, you can have sexual problems.

Some common causes include:

• Emotional causes, such as stress, relationship problems, depression or anxiety, a memory of sexual trauma, and unhappiness with your body.
• Physical causes, such as hormone problems, pain from an injury or other problem, and certain conditions such as diabetes or arthritis.
• Aging, which can cause changes in the vagina, such as dryness and stiffening.
• Certain medicines that can cause sexual problems. These include medicines for depression, blood pressure, and diabetes.

What are the symptoms?

Sexual problems can include:

• Having less desire for sex.
• Having trouble feeling aroused.
• Not being able to have an orgasm.
• Having pain during intercourse.

How are sexual problems in women diagnosed?

Women often recognize a sexual problem when they notice a change in desire or sexual satisfaction. When this happens, it helps to look at what is and isn't working with your body and your life. For example:

• Are you ill, or do you take a medicine that can lower your sexual desire or response?
• Are you stressed or often very tired?
• Do you have a caring, respectful connection with a partner?
• Do you and your partner have the time and privacy to relax together?
• Do you have painful memories about sex or intimacy?

Your doctor can help you decide what to do. He or she will ask questions, do a physical exam, and talk to you about possible causes.

Some women find it hard to talk to their doctor about sexual problems at first. Sometimes it helps to write out what you want to say beforehand. For example, you could say something like “For the past few months, I haven't enjoyed sex as much as I used to.” Or you could say "Ever since I started taking that medicine, I haven't felt like having sex.”

How are they treated?

Treatment for sexual problems depends on what is causing the problem. There may be one or more issues causing the problems. Many sexual problems can be worked out once you know the cause or causes.

Sex involves emotional, physical, and relationship issues. Successful treatment requires a high level of comfort between you and your doctor. Ideally, you and your partner will also be able to talk openly about sexual concerns. Treatment may include treating health problems, getting communication counseling, and learning about things you can practice at home. For example, you might take a warm bath to relax, have plenty of foreplay before sex, or try different positions during sex.

A woman's sexuality is a complex mix of mental, emotional, and physical signals. A problem in one area can grow to involve others. For example, a physical problem can lead to fear of pain, and the fear can lead to guilt about its effect on your partner. So the causes of sexual problems in women are often interrelated.

Psychological causes may be related to past or current physical or emotional problems. These mental and emotional causes include:

• Stress.
• Marital or relationship discord.
• Previous pelvic trauma.
• Involuntary and often painful contractions of the vagina (vaginismus), sometimes linked to memories of pelvic trauma or abuse.
• Depression.
• Fears that illnesses, such as cancer, or surgery, such as a mastectomy or hysterectomy, will make sexual activity unpleasant for the woman or her partner.
• Unhappiness with body image.
• Anxiety.

Physical causes can be normal hormonal changes, injuries, medical procedures, or other medical problems. Physical causes include:

• Hormonal changes such as those related to the menstrual cycle, use of birth control pills or hormone therapy, pregnancy, recovery from pregnancy, perimenopause, and postmenopause.
• Pain during intercourse. This may result from:
  • Physical changes from surgery, radiation therapy, or other medical procedures.
  • An injury.
  • A physical abnormality.
  • Vaginal dryness.
  • Painful, involuntary contractions of the vaginal muscles (vaginismus). This is sometimes linked to the body's "memory" of pelvic trauma or abuse.
  • Genital herpes.
  • A vaginal infection (vaginitis).
• Medical conditions, including diabetes, arthritis, urinary incontinence, urinary tract infection, stroke, coronary artery disease, hypertension, atherosclerosis, multiple sclerosis, hypothyroidism, endometriosis, or a nervous system problem (neurological disorder).

Aging may cause a decrease in sexual desire and changes in the vagina. These changes include:

• Increased vaginal sensitivity, so that the vagina may be easily bruised or chafed.
• Narrowing, shortening, and/or stiffening of the vagina, causing pain during intercourse (dyspareunia).
• A reduction in lubrication and a lengthening of the time needed to lubricate the vagina.
• More time needed to feel sexually aroused.
• Orgasms that do not last as long they once did.

Medication use can sometimes decrease sexual desire and arousal. Such medications include:

• Blood pressure and diabetes medications, such as diuretics, alpha-blockers, beta-blockers, and calcium channel blockers.
• Antidepressants. These include tricyclics and selective serotonin reuptake inhibitors (SSRIs).
• Antihistamines, which are allergy medicines.
• Opioids and tranquilizers. Opioids are used to treat pain. Tranquilizers are used to calm the nervous system.
• Appetite suppressants. These are also known as diet pills.
• Chemotherapy for cancer.

Losing a partner is a common life event that can lead a woman to be less sexually active and satisfied. This is not a "sexual problem," but it can leave you with unmet needs for intimacy.

Cultural and societal factors may play a role in a woman's sexual health. Inadequate health services and/or a lack of sex education may result in a woman's lack of knowledge about sexual behavior. In addition, a woman may feel unable to meet the societal standards of attractiveness or sexuality, or she may believe herself to be incapable of meeting family and cultural expectations of a woman's role in life.¹

Drinking alcohol to excess may increase the time it takes for a woman to reach orgasm. In addition, some women who feel sexually inadequate when sober may drink to mask those feelings temporarily. Alcohol can play a role in creating a cycle of drinking and sexual problems.

Symptoms of sexual problems can include:

• A decrease in the level of desire, which might be expressed by fewer sexual fantasies or thoughts and a reluctance to engage in sexual activity.
• A decrease in the level of arousal. A woman may notice that she feels unreceptive to sexual suggestions and is not able to feel or maintain sexual excitement.
• An inability to reach orgasm after sexual stimulation. (For most women, the clitoris is the main site of orgasm. Not all women have vaginal orgasms.)
• Pain during intercourse.

By definition, sexual problems are symptoms that are distressing for you and/or your relationship with a partner. If you have a symptom that you are not troubled by and that isn't causing a relationship problem, then it is not considered to be a sexual problem.

Most women have a sexual problem at one time or another. For some women, the problem is long-term. Surveys of the general population in the United States found that many women occasionally have sexual problems and worries, including:²

• Concerns about sexuality (6 out of 10 women).
• Lack of interest in sex (3 out of 10 women).
• Sex not always being pleasurable (2 out of 10 women).
• Pain with intercourse (1 to 2 out of 10 women).
• Difficulty becoming aroused (5 out of 10 women).
• Difficulty reaching orgasm (5 out of 10 women).
• Not being able to have an orgasm (2 to 3 out of 10 women).